Envisioning 2.0

Over the past several months, I have had the privilege of speaking with a number of well-regarded scientists, physicians, epidemiologists and social scientists about a very contentious issue: race and medicine. I have been pleased that so many distinguished individuals have been willing to speak publicly and candidly about this difficult subject.

Although those I have interviewed have many different perspectives on this subject, a few common themes shone through. Most importantly:

-Race is social construct with biologic and economic consequences: I was speaking about race and medicine with the head of a major medical association the other day. During that conversation he said: “What is the difference between a white horse and a black horse? None. Yet, we make a big deal of differences between whites and blacks. Why do we do this?”

As many of the people I interviewed observed: At its simplest, race is a social construct, a means of grouping people. Yet, race has many consequences: social, economic and medical. While there are no significant differences between groups of people, race has consequences. Especially on health outcomes and how people metabolize different medications.

-The pharmaceutical industry and government need to do more to address racial disparities: Many of the people I interviewed said that drug companies need to do more to educate ethnic minority patients on risk factors and behaviors that can result in improved health. Some companies, like NitroMed (see the interview below) are making an effort, but more needs to be done. Especially in areas where there is little or no financial incentive to do so. Government can and should play a role in promoting social and health equity.

-Health disparities are real and persistent: A major theme of my interviews was disparities in healthcare. Everyone agreed that disparities are real, persistent and deserve increased attention.

I hope you have enjoyed this interview series and found it informative. While this is my final interview, I will certainly touch on this issue in the future. Click here to read the other interviews I have published on race and medicine over the last few months.

Read on for my interview with Dr. Michael Sabolinski of NitroMed.

About Dr. Sabolinski: Dr. Sabolinski is Chief Medical Officer of NitroMed. He has more than 20 years of experience in clinical research and medical products development. He joined NitroMed in 2002 after completing a distinguished decade long career with Organogenesis, Inc. where he held several positions including President and Chief Executive Officer, Head of Clinical Research, Regulatory Affairs and Corporate Development. During his tenure, he successfully managed the team that secured two FDA approvals of a living skin substitute, pioneering the path for stem cell products and other cell therapies.

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Race-based medicine, or the practice of treating people differently based on their racial and ethnic background, has long been a subject of interest to healthcare providers, public health practitioners, communicators and others. Now, with the introduction of BiDil, the first medication approved for the treatment of a condition in a specific race (African Americans), the topic is once again gaining increased attention.

Given the intense interest in this subject, I am conducting a series of periodic interviews with physicians, social scientists and others. Each interview subject provides his or her unique perspective on race-based medicine, which I then publish on this blog. Please click here to read the other interviews in this series.

Interview Subject: Dr. Brian Smedley

About Dr. Smedley: Dr. Smedley is research director and co-founder of the Opportunity Agenda, a communications, research, and advocacy organization dedicated to building the national will to expand opportunity in America. Prior to joining the Opportunity Agenda, Dr. Smedley was senior program officer in the Division of Health Sciences Policy of the Institute of Medicine (IOM), where he was study director for the IOM report, Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care.

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On Monday, the Wall Street Journal published a front-page story containing some interesting revelations about the New England Journal of Medicine’s (NEJM) handling of a November 2000 article comparing Vioxx’s impact on stomach ulcers to naproxen. The article, written by David Armstrong, indicates that:

-NEJM may have published a December 2005 editorial “expressing concern” about the Vioxx publication to divert attention from a deposition by Executive Editor Gregory Curfman. In his deposition he admitted that the NEJM did not edit the article properly and may have helped downplay the cardiac risks associated with Vioxx.

-NEJM’s claim that the study authors deleted data from the article pertaining to Vioxx’s impact on the heart in its 2005 editorial was misleading. According to the Journal: “one of the ‘deleted items’ was a blank table that never had any data in it . . . also deleted was the number of heart attacks suffered by Vioxx users in the trial – 17.” This data was replaced with a percentage figure. .04 percent (or 17) of the 4,047 patients in the trial suffered heart attacks. Curfman later admitted that it would have been clearer to include the original figure.

-The NEJM sought counsel from a public relations consultant, Edward Caffasso, on how to manage the potential negative publicity from Curfman’s deposition. He supported the timing of the NEJM’s editorial and said it would “drive the media away from NEJM and toward the authors, Merck and plaintiff attorneys.” In addition, a list of message points provided to journal editors encouraged them to “deny that the journal’s statement was connected to the federal trial.” It is not clear who wrote the message points.

The Journal’s article does not make anyone look good. It is clear that something went wrong and that a lot of people were less than honest.

CYA At NEJM: The Buck Stops Anywhere But Here

NEJM is one of the most prestigious medical journals in the world. A vast majority of submitted articles are rejected for publication and the journal is well-respected for its editorial rigor. However, it is clear that the NEJM made some mistakes in its handling of the Vioxx article. It is also apparent that the journal is passing the buck and refusing to take responsibility for its role in the article’s publication.

Granted, the journal relies on authors to provide accurate and complete information about studies. However, given its reach and influence editors need to ensure that it asks tough questions about all studies it publishes. CYA is not an optimal strategy.

The PR Lesson: Sometimes Spin Boomerangs

The NEJM was worried that Curfman’s deposition and the timing of its editorial might make it look bad. So, it asked a public relations consultant for advice. The Journal article indicates that the consultant broke the first rule of crisis communications: tell the truth, the whole truth and nothing but the truth. It may make you look bad in the short run, but people will appreciate your candor.

The Journal article is a perfect object lesson on why telling the truth is better than spouting spin. You may get away with it initially, but things like this tend to come back to harm you when you least expect it. In 2005, Caffasso said: “The story is playing out exceptionally well.” Mr. Caffasso, that’s no longer the case.

John Mack over at the Pharma Marketing Blog and Derek Lowe at In the Pipeline have more on this story.

Following is my contribution to an innovative project Jack Mason of HealthNex has started. It is called Blogposium, a “three-day collaboration of healthcare bloggers to expand the Clinical Informatics Wiki.”

Please help us make this effort a success by making comments and providing edits to each entry. You can find additional Blogposium submissions at the following blogs:

• Christina’s Considerations: Regional Health Information Organizations
• eHealth: Integration of Personal Health Records and Electronic Medical Records
• EMR and HIPAA: Electronic Medical Records and Biometric Integration
• HealthNex: Biobanking, Patient Experiential Data and Genetic Privacy Issues
• HITsmit: e-MAR Systems
• HIT Transition: RHIO Startup Funding and Finance
• Marketplace.MD: The Consumer-Driven Health Care Movement
• medmusings: Mobile Access to EMR/EHR/PHR for Providers and Patients
• Usemed: Ongoing and Completed EHR, CPOE and CDS Implementation Projects

My entry, focusing on the impact of SMS and blogs on the patient-provider relationship is below.

SMS, Blogs and the Patient-Provider Relationship: Enhancing Communication, Improving Treatment Outcomes

The healthcare provider-patient relationship is one of our most valued and important connections. This is true across a range of countries and cultures. For example, according to a 2003 study presented at the World Medical Association, people ranked their relationship with their physician as second only to their connection with family members.[1] Another study indicates that people want their physicians to have good communications skills, to be accessible and to partner with them to help them achieve good health.[2]

Unfortunately, patients and medical professionals face significant obstacles to building strong, positive relationships. One barrier is time. Many medical professionals complain that they have limited time to address all of their patients’ needs during a visit. Another challenge is behavior, specifically patient noncompliance with medication and missed appointments. It is difficult for providers to build rewarding connections with noncompliant patients or those who do not show up for sessions.

Fortunately, patients and medical professionals have access to a number of inexpensive and easy-to-use technologies that they can use to enhance communication, increase compliance, limit no-shows and improve treatment outcomes. This article focuses on how two of them, text messaging and blogs, can improve the patient-provider relationship and medical management.

Definitions: Text Messaging and Blogs

Text Messaging (SMS)

Short Message Service (SMS) or text messaging is a mobile phone technology that enables people to send and receive text messages (usually no longer than 160 characters) to cell phone or computer users.

Blogs

Blogs are Web sites containing an archive of content in reverse chronological order.[3] Over the past decade, blogs have increased in popularity because they enable people to publish content to the Web without having a great deal of technical expertise.

SMS and the Patient-Provider Relationship

As indicated above, two significant barriers to the development of a positive patient-provider relationship is noncompliance and patient no-shows. Evidence is building that SMS may be an inexpensive and efficient way to solve both of these problems.

Reducing Missed Appointments Using SMS

Missed appointments are a significant problem in many countries, especially in Britain. It is estimated that patient no-shows cost the National Health Service (NHS) about £575 million annually.[4] Some studies suggest that SMS may help reduce the rate of missed appointments. For example, a trial conducted at London’s Homerton Hospital indicates that SMS helped reduce missed appointments at the institution’s Department of Sexual Health by eight percent.[5]

Improving Compliance and Treatment Outcomes with SMS

As medical professionals are all too aware, it is very difficult to monitor patients to ensure they comply with therapy. Using SMS may be one way to increase patient compliance and improve treatment outcomes.

A study published in early 2006 in the journal Sexually Transmitted Infections indicates that patients who receive text messages may be more likely to seek treatment. Patients using SMS took less time to get treated (an average of nine days versus 15 for those not receiving text messages) and used fewer staff resources.[6]

In the United States, healthcare providers have been using SMS to help patients take an active role in their diabetes treatment. In one study, researchers used a text messaging service called “Sweet Talk” with teenage patients. Each day the patients received a reminder to take their medication. Patients that received text messages felt that their treatment was much improved and had better control of their blood glucose levels.[7]

These studies indicate that SMS may help patients have more productive and rewarding relationships with their healthcare providers because they will be more likely to show up for appointments, comply with therapy and have better treatment outcomes.

Blogs and the Patient-Provider Relationship

In 2005, Harris Interactive reported that 117 million Americans regularly turn to the Internet for healthcare-related information.[8] This statistic indicates that the Web has become an important tool for people seeking to become educated about medical conditions.

The Internet is also having an impact on the patient-provider relationship. Traditionally, patients have viewed providers as their primary source of healthcare information. With the advent of the Internet, patients no longer relied primarily on healthcare providers for medical information. They began to gather medical content from the Web and share it with healthcare providers.[9] Today, a significant proportion of medical information available on the Internet is published on blogs and other sources of consumer-generated content (i.e., bulletin boards, podcasts).

With increased education, patients began to feel more comfortable partnering with healthcare providers rather than relying on them to make the majority of medical decisions.[1]

Blogs enhance the provider-patient relationship because they enable both parties to apply and share highly relevant medical information. Blogs can also improve relations between medical professionals and patients by:

- Facilitating Patient-Provider Communication: Blogs can provide an opportunity for patients to ask anonymous questions of providers about how to identify and manage medical conditions. Providers can use blogs to educate patients and direct them to credible sources of healthcare information. However, patients should always be warned that a blog is no substitute for professional, customized medical advice.

- Enhancing Patient Therapy: Some healthcare providers are prescribing blogs to patients as a part of their therapy.[9] They ask patients to use blogs to relate their experiences and share information and insights with others.

- Informing Providers About Best Practices: Patients and healthcare providers can both benefit from the careful application of evidence-based medicine and best practices. Blogs can be a good source of detailed information about how to manage common and rare medical conditions. One example of a good “treatment” blog is Clinical Cases and Images, which physicians at Case Western Reserve University maintain.

Drawbacks

While blogs and SMS have the potential to improve the patient-provider relationship, there are a few drawbacks to these technologies:

- Patient Privacy: Before the use of SMS becomes widespread in patient care, healthcare providers will have to determine ways to preserve patient privacy. With blogs this is less of a problem, as people can post content anonymously.

- Lack Of Data: While investigators have conducted a number of studies examining the benefits of SMS on patient care, additional information is required. Moreover, there has been no systematic review of healthcare blogs to determine if they have a positive impact on the patient-provider relationship or treatment outcomes.

- Access Issues: While SMS technology is available in most parts of the world, many do not have regular access to the Internet. The digital divide between and within countries may hamper the widespread adoption of blogs by medical professionals and patients globally.

References

1. Magee, M. Relationship-Based Health Care in the United States, United Kingdom, Canada, Germany, South Africa and Japan. in World Medical Association Assembly September 11 2003. Helsinki, Finland
2. Anonymous, Future Of Family Medicine: Selected Quantitative and Qualitative Research Findings. 2002, Future of Family Medicine Leawood, Kansas.
3. Anonymous. Blog. 2006 February 16, 2006 [cited 2006 February 19]; Available from: http://en.wikipedia.org/wiki/Blogs.
4. Atun, R. and S. Sittampalam, A Review of the Characteristics and Benefits of SMS in Delivering Healthcare, in The Role of Mobile Phones in Increasing Accessibility and Efficiency in Healthcare. 2006, Vodaphone Group. p. 18-28.
5. Dyer, O., Patients Will Be Reminded of Appointments by Text Messages. British Medical Journal, 2003. 326(7402): p. 1281.
6. Menon-Johansson, A.S., et al., Texting Decreases the Time to Treatment for Genital Chlamydia Trachomatis Infection. Sexually Transmitted Infections, 2006(82): p. 49-51.
7. Anonymous, A Text a Day . . . , in The Economist. March 25, 2006. p. 95.
8. Anonymous. Number of “Cyberchondriacs” – U.S. Adults Who Go Online for Health Information – Increases to Estimated 117 Million. 2005 July 15 [cited 2006 March 19]; Available from: http://www.harrisinteractive.com/harris_poll/index.asp?PID=584.
9. Johnmar, F., The Emerging Healthcare Blogosphere: What Is It & Why Does It Matter? . 2006, Envision Solutions, LLC. New York, NY.

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I thought I’d add to the “explosion” (pun intended) of commentary about the latest PR blogger to hit the scene: the sexy “Strumpette” or “Amanda Chapel.” She (or it) is getting lots of buzz, so I’d thought I’d draw attention to my quiet, serious, low-circ blog by mentioning her, or it, or whatever. For anyone who cares, this is an obvious attempt to garner “link love” — but for a good cause, so read on.

Outing “Strumpette”

It appears that “Amanda” may be close to being outed. In a comment posted on Robert French’s blog infOpinions?, Mike Driehorst says:

“Now, I know relatively little about technology. So, the following may be hogwash, and no harm is meant by it. But . . .

I found the IP address for Ms. Chapel’s comment at:
http://www.contentmanager.net/community/forum/11/15/16.html
It’s a discussion through about “Miro International Supports Mambo Open Source Community in Disputing Furthermore Claims”
Ms. Chapel’s comment IP address is the same as someone named “Furthermore” in that discussion.

If you follow the link by “furthermore”:
http://www.literatigroup.com/versusmambo/content/view/54/46/1/2/
that is in that discussion, you get to a statement about Miro International. In that statement, there is reference to a Brian Connolly of Chicago-based Furthermore Inc.

Mr. Connolly had a couple comments on Steve Rubel’s blog in February about the Edelman Talk Shop look and brand: http://www.micropersuasion.com/2006/02/talking_shop.html

Mr. Connolly’s Furthermore Inc. publishes wepublishing.com, a platform for managing Web community information.

So, is there a legit connection between Ms. Chapel and Mr. Connolly? Or, has my inept tech expertise been exposed?”

Now For The Legit Stuff: Healthcare Non-Profits That Deserve Link Love

Robert French has been asking people to share some link love with non-profits to draw attention to their activities and to support their blogging efforts (see this post.) I’ve nearly completed my massive report on healthcare blogging and there is a big section in it on healthcare non-profit blogs. So, here’s me giving link love to the non-profit blogs I highlight in my report. Visit their blogs, support them (if you agree with their cause) and link to them. Now, the list:

Healthcare Non-Profit Blogs

-Planned Parenthood: Save Roe!
-The March Of Dimes: Share Your Story
-The Amercan Lung Association Of Minnesota
-The Hastings Center: Bioethics Forum
-The MIRACLE Campaign
-The Constellation For AIDs Competence
-Camp ASCCA Journal
-A Healthy Blog

That’s all folks. . .

Update: Kate Steadman’s got a great post on her blog about pricing transparency and what it isn’t going to do. Check it out by clicking here.

A heated debate has recently flared up over the Bush Administration’s proposal that hospitals disclose the prices they charge for medical services. The Administration believes that publicizing this information will make it easier for individuals – who they would like to see using Health Savings Accounts (HSAs) – and insurance companies to choose cost-effective care. The Administration also wants hospitals to publish information about the quality of their services.

Given the Administration’s preference for market-based healthcare solutions, it is easy to see why it wants hospitals to disclose this information. Advocates of consumer-driven healthcare have long argued that in order for individual healthcare consumers to use medical goods and services cost-effectively, they need the following information:

-Healthcare cost information
-Information about the quality of healthcare goods and services

Armed with these two pieces of data and a set budget (read: HSAs), some economists suggest that healthcare utilization would decrease and costs would go down.

However, I wonder whether publicizing hospital pricing information will have the desired impact. First, patients with health insurance do not pay directly for hospital services. Second, while Administration officials have suggested that public pricing data will help the uninsured “shop for less expensive treatments,” I’m not so sure.

If forced to publicize pricing data, hospitals may set uniformly high prices to protect their profit margins. If this happens, how will public pricing data help the uninsured patient visiting the emergency room for a condition that could have been prevented if they had regular access to a physician?

Pricing transparency is an interesting idea, but given the structure of the US healthcare system, I’m not sure if it will have the desired impact. Most people are not shopping on the free market for healthcare goods and services. As for the uninsured, it’s more cost-effective (for them) to provide them with insurance so that they can benefit from the low rates negotiated by the managed care industry or government.

(Via Matthew Holt’s Fierce Health Care)

Tom Foremski’s suggestion that we kill off the press release has gotten a BIG reaction from the blogosphere. In his cleverly titled post Die! Press release! Die! Die! Die! Tom says:

“Press releases are nearly useless. They typically start with a tremendous amount of top-spin, they contain pat-on-the-back phrases and meaningless quotes. Often they will contain quotes from C-level executives praising their customer focus. They often contain praise from analysts, (who are almost always paid or have a customer relationship.) And so on…”

First, I’ll say that I agree with Tom – in part. I recently wrote an article urging communications professionals, corporations and others to kick the press release habit. In my article, I suggested that many press releases are unnecessary and people should try to find other ways to communicate relevant information to the media.

However, I do not advocate that we execute the press release. In fact, I think that — at times — press releases can be very useful documents, especially in healthcare.

Healthcare is highly complex and sometimes controversial. In many cases, journalists rely on press releases for the basic facts about the latest clinical trials, company earnings, important surveys, public health initiatives and a host of other topics. I can’t count the number of times healthcare media have asked me to send them a press release so that they can vet a story – on their own time.

Can you imagine journalists trying to make sense of these recent healthcare stories without a press release?

- The Women’s Health Initiative: Low Fat Diets Do Not Prevent Heart Disease

- Novo Nordisk: Despite Recent Reports, We Operate Ethically (The company released this statement, in part, to responsed to a recent New York Times article reporting that the company had paid off at least one Rite Aid pharmacist to switch patients to its medications.)

Now, I’m not saying that every healthcare-related press release is useful. However, I think that some of them serve a purpose and I couldn’t imagine communicating efficiently without them.

As for Tom asking press release writers to use Web 1.0 and 2.0 technologies like tags and links . . . Well, I think it’s a good idea, but that’s early adopter, cutting edge type stuff. It will be a long time before you get folks in corporate communications departments and other organizations comfortable with those types of add ons. I guess we’ll have to stick to rubbing two sticks together to ignite media interest in our stories.

I’ll end this post with a quote from Susan Getgood who writes Marketing Roadmaps. She had this to say about the press release:

“The practice of public relations is not defined by the press release. Yes, it has its problems, but these will not be solved by getting distracted by the press release red herring. We have to stay focused on the larger issues — how to improve the practice of PR, how to integrate the new media (without throwing out the baby), and ultimately, how to best serve the communication needs of our clients and companies, irrespective of the tool. Need a chisel, use a chisel. Need a mallet, use a mallet. And so on.”

Susan, I couldn’t agree more. (By the way, read Susan’s post on this issue. She’s got a great overview of other blog posts focusing on Tom’s article.)

Update: Shel Israel, co-author of Naked Conversations, recently posted about a chat he had with an exec who says vendors are urging pharma to blog. He reports that Pfizer is too scared to blog because of fear of regulation. Shel: The next time you’re talking with a pharma exec, please direct them to the essay below. I think it may help to alleviate any fears pharma has of the blogosphere.

Original Post: Recently, I have been conducting research for a report I am developing on blogging in healthcare. Shahid Shah, a healthcare IT expert and a corporate blogging evangelist, graciously agreed to be interviewed for the report.

Shahid is well-known in healthcare blogging circles and beyond. He was recently interviewed by Backbone Media about healthcare blogging. Shahid runs the HITSphere blog aggregator as well as his own Healthcare IT Guy blog. He was also featured in DataMations magazine’s recent Blogging Your Way Up the Career Ladder article.

Given Shahid’s expertise on this subject, I decided to invite him to talk with a little more specificity about pharmaceutical and regulated products blogging. His article appears below.

Corporate blogging is certainly not new but it hasn’t really taken off because executives are always nervous about public statements they make, especially if they run a public company. Until now only small firms, who have much to gain with direct 2-way contact with their customers, have really engaged their clients through blogs. Now, however, even the big companies as different as McDonalds and Microsoft have become corporate bloggers with different degrees of success.

The pharmaceutical industry is certainly one group of companies that could use increased goodwill that comes from direct contact with their customers. If anyone should be blogging from a corporate perspective it should be big pharma because what it does directly touches the lives of its customers in a way very few other industries do. The level of importance people give to their health and the way that they bond with their healthcare providers (and by extension the drugs they take) is very important. Most pharma companies are worried about the FDA and cite that as a big concern about why they don’t blog. But, I think that’s a mistake.

Pharma shouldn’t worry too much about what the FDA has to say specifically for blogs. Blogging does not impact anything that wouldn’t already be public anyway. For example, if a pharmaceutical firm has a call center where they answer questions about their drugs’ on-label use, a blog would be no different. In fact, drug firms can improve customer service by providing tips, tools, and guidance on how best to use their drugs. I would recommend that firms start to create blogs that start to tell stories of why scientists (in their own words) are focusing on certain diseases, how far technology has come along, how exactly drugs go from an idea to discovery to production. All these would bring customers closer to them, not alienate them. And, the FDA won’t complain about anything that doesn’t cause off-label use. Fard and I spoke with an FDA counsel this week and they basically said the same thing (without providing specific or official legal guidance). Anything that’s covered by existing guidance would apply to blogs, too.

If a drug vendor starts a blog or discussion forum about its products and doesn’t mis-communicate about efficacy of its products or fitness for a particular purpose it shouldn’t get into trouble. Companies won’t have problems with regulators if they stick to the truth about their products and improve the way customers interact with them. That doesn’t mean they shouldn’t be careful about what they say — but that goes for anything a company says. It’s not something special to blogging but blogging does make it easy for people to say whatever they want (like folks do in an email).

So, if you’re not blogging today don’t blame the feds. If you’re not creating corporate blogs, it’s due to a lack of vision and innovation and perhaps a lack of respect of your customers, not the FDA. Guys like me and Fard can help you devise an appropriate strategy to allow direct communication, improved customer service, and who knows in a few years people may stop thinking of big pharma in a poor light like they do now.

Oh, and by the way, don’t think that just because you’re not blogging about your own products that nobody else is. Nature abhors a vacuum but so does the blogging community. Third parties are already talking about your drugs and company in their own blogs and forums. Why not take the initiative and help navigate people to the “official” word about your drugs?

With the airwaves and Internet filled with talk of large-scale health promotion initiatives, it can be hard to remember that sometimes the best way to reach and teach people is face-to-face.

I was reminded of this truism while reading an article from this week’s New Yorker magazine. The article, titled “Swamp Nurse,” focuses on the efforts of “professional nurturers” working in the Louisiana Nurse-Family Partnership program. This initiative attempts to improve the health and lives of babies born into poverty throughout the state.

Katherine Boo, the author of the article went to the swamps of Louisiana to detail the efforts of nurses working in the Partnership program. The main protagonist of her article is a nurse named Luwana Marts who travels the highways and byways of Louisiana teaching young mothers how to better care for their babies.

The New Yorker posted an interview with Boo on its Website this week where she outlines the reasons she went to Louisiana to chronicle the program. Excerpts from this interview follow.

On why Boo did this story.

I was drawn to the Nurse-Family Partnership because it’s an attempt to help mothers develop their babies’ minds in situations in which . . . the mothers are often children themselves, and the intergenerational conflict is of a level and an intensity that would have made Erskine Caldwell flinch.

On why Boo went to Louisiana.

[I]t seemed fitting to me to follow . . . nurse-visitors in what is, demographically speaking, [not a very] promising setting. [I found] these bureaucrat-nurses were smart, resourceful, and surprisingly cheerful given the fact that they earned very little and were walking most days into the dark heart of adolescent mama-drama.

On what makes the program work.

[Part of what makes the program work is that] the interveners are nurses—professionals who, in poor communities, are free of the social stigma that child-protection investigators or other social workers may possess.

Nurse to mother, mother to child . . . this program represents the best kind of health communication: intimate, relevant and hands-on.

Needless to say, blogging is a hot topic right now within and without the pharmaceutical industry. Corporations from Microsoft to McDonalds have developed blogs that have helped them to better engage their customers (with varying degress of success).

The pharmaceutical industry however has been slow to jump on the blog bandwagon. It is not hard to see why, as the industry is highly scrutinized and intensely regulated. Given this, it may have surprised some that Lilly ICOS, makers of the anti-impotence medication Cialis, had decided to enter into the blogosphere. Pharmaceutical Executive reported in October 2004 that “Eli Lilly and Icos . . . publish the Cialis Blog” (www.cialisblog.com). Given this report, it appeared that Lilly ICOS had successfully managed the numerous legal and regulatory issues associated with developing and publishing an offical blog.

This would be great news — if it were true. It turns out that the Cialis blog is not endorsed by the powers that be at Lilly ICOS, according to Lilly spokesperson Kindra Strupp. I asked Strupp about the blog while conducting research for a report I am developing on blogging in the healthcare industry.

I’m not sure what caused the confusion about the blog, but it may have been the fact that the blog features the Cialis logo prominently and provides information about Cialis clinical trials. Prior to my contacting Lilly, the company was unaware that the Cialis blog existed.

This case of mistaken blog identity highlights one key reason that pharma may want to jump into the blogging world. Developing a blog may provide industry with the opportunity to ensure that the public is presented with a fair and balanced perspective on the medications they manufacture. At the very least, industry should monitor the blogosphere to ensure they know what is being said about their products. More importantly, industry can also identify, monitor and regulate blogs that leave the impression that they are company-sponsored.