Envisioning 2.0

I was turned on to a lengthy eight-part blog post focusing on the death of “viral marketing” by my friend and fellow Amherst grad, Mike Arauz from the folks at MIT.  He’s written a response/reaction to the posts by Henry Jenkins and his colleagues that’s well worth your time.  And, when you have about an hour to spare, read (and cogitate on) the original series by Jenkins.

Devices like the iPhone are taking the world by storm and igniting the once-moribund mobile Internet market.  Lots of people are discovering the joys of being able to access the Internet from anywhere.

As exciting as these developments are, there are some signs that marketers may be moving quickly to take advantage of the mobile phone’s rich capabilities, but paying less attention to privacy concerns.  According to an article published in today’s New York Times:

“Advertisers are eager to use [behavioral and psychographic] information for much more specific targeting . . . An advertising system could know, for instance, that someone is 27 years old, male, a New England Patriots fan (which NFL.com can track), plays Blackjack, travels frequently between Boston and New York on weekdays (which applications using GPS can track) and uses a 3G iPhone. That would make him attractive to a host of advertisers, like the Delta Shuttle or a Las Vegas hotel, whose ads would appear while the consumer was browsing the Web on his phone.”

I believe that having in-depth information about a target population can help us better understand their preferences, attitudes and beliefs.  However, marketers should figure out ways to educate people on how their information is used or allow them to opt-in to take part in this type of research.

This is why I am happy the Mobile Marketing Association is updating its policies and procedures for effective and ethical mobile research and marketing.  If marketers don’t take steps to self-regulate their activities and demonstrate they are operating in an ethical matter, regulators and public officials will step in.

In 1993, President Bill Clinton began a health reform process that he hoped would expand coverage to many of the nation’s uninsured.  He said that his proposal would reduce health costs, increase our health security and preserve Americans’ choice of medical providers.  Nearly a year later, Clinton’s effort to pass comprehensive health reform had ended.  It had fallen prey to a number of outside factors, including a significant lack of public support for his agenda.

Today, more than 15 years later, another Democratic President is launching an effort to overhaul the US health system.  Today, during a white house conference on health reform attended by politicians, health industry insiders and others, President Obama said:

“In this [health] effort, every voice has to be heard. Every idea must be considered. Every option must be on the table. There should be no sacred cows. Each of us must accept that none of us will get everything that we want, and that no proposal for reform will be perfect. If that’s the measure, we will never get anything done. But when it comes to addressing our health care challenge, we can no longer let the perfect be the enemy of the essential.”

Obama has also taken steps to build momentum for reform by increasing funding for the children’s health insurance program (SHICP) and allocating money in the federal budget for a new health insurance scheme.  By focusing on the costs for a program first, he has removed one major objection to reform.

However, by saying that he wants to get “something” done rather than insisting that a reform bill be perfect he is clearly willing to undergo a process of give and take with others in an effort to solve the problem of the uninsured.  Nearly everyone agrees that we need to do more to increase the ranks of the insured.  What we disagree on is how to do it.

One thing is certain, Obama is a very popular president who has already shown great ability to mobilize a grassroots army in support of his proposals.  I’m looking forward to seeing how he and his advisors use them.

Image Source: HealthReform.gov

Last week, a new medical wiki, Medpedia, received significant attention when it announced that several major medical institutions, including Harvard Medical School, were partnering with the startup.  Mark Senak who writes at Eye on FDA, suggested that “when given a choice of learning about the drug from (1) the manufacturer or (2) an objective third party source representing the finest medical schools in the country, patients and physicians are likely to gravitate to the objective resource.”  He also believes that “the influence of Medpedia on prescribers . . . and patients stands to be quite large.”

While Medpedia allows anyone to contribute information, it only gives physicians or PhDs the ability to serve as editors.  These highly credentialed individuals will have the final say on what content ultimately makes it into the online publication.

This restriction has incensed some advocates of full and equal patient participation in medical information sharing, development and dissemination.  In an impassioned post published recently on e-patients.net, Dave deBronkart took Medpedia to task for restricting access to the site.  He wrote: “[W]hat patients need from an online resource is reliable information on topics where they’re not experts . . . And my experience is that it’s an error to presume that doctors inherently have the best answer[s].”

To his credit Medpedia founder James Currier responded to deBronkart’s essay, saying: “I want to make it clear [patients] ARE being invited in.  There are already several key features that anyone — whether medical professional, expert patient, or layperson – can use to engage.  Anyone can create a profile.  Anyone can create or join a Community of Interest to connect and debate (they are admittedly rudimentary today but will be improving in the coming months), and anyone can use the Suggest Changes feature on every Article page. Use these features vigorously.”

The ongoing debate over Medpedia and its editorial policies illustrates – yet again – that some Internet empowered patients and caregivers are chaffing and outright rebelling at the traditional hierarchy of the medical establishment.  Although they respect physicians, they do not automatically view them as the most authoritative source of health information.

In fact, according to a study my firm Envision Solutions published last year, thirty-eight percent of U.S. adults say they have doubted a medical professional’s opinion or diagnosis because it conflicted with information they found online.

Because a good number of physicians believe that a lot of online medical information is of low quality, they worry that patients are second-guessing their advice (or orders) based on shoddy information.  Is Medpedia an attempt by the medical profession to ensure that (via the magic of search engines) content a broad range of content physicians have vetted finds its way into the hands of patients and others?  Would it be a stretch to posit that some people behind Medpedia wish to dampen the disruptive impact of the Internet by ensuring that content people are seeing is consistent with broad medical practice or opinion?  After all if the information patients are reading is consistent with standard medical advice there is less room for disagreement.

The Medpedia debate is another skirmish in the war medical professionals and active laypersons are fighting over the future of medicine.  E-patients like deBronkart trust physicians, but know they are prone to errors of fact and omission.  Medpedia respects the contributions of patients, but  maintains that “physicians and Ph.D.s in the biomedical fields have gone through extensive training and screening before receiving their degrees, and those degrees can serve as an efficient proxy for the Medpedia community to judge an Editor’s ability to contribute accurate and up to date information to the encyclopedia.”

In the end it comes down to what credentials one believes makes people best qualified to develop medical content: a degree + clinical experience or extensive research + personal experience.  It’s clear where the creators of Medpedia come down on this question.  Where do you stand?

A significant part of the recently signed stimulus package (at least for people in the health industry) is comparative effectiveness research.  Now that the bill has become law, government agencies will be required to conduct large-scale head-to-head clinical trials to determine which prescription medications are truly superior.

Some pharmaceutical industry stakeholders and physicians do not like comparative trials, and their experience with the ALLHAT trial illustrates some of the reasons why.  The ALLHAT trial demonstrated that generic blood pressure medications are better than more expensive alternatives.  The results sounded good until prominent physician thought leaders began to take the data apart and suggested that the government skewed the study results.

More troubling is that some doctors said the government based the study on poor outcomes experienced by African American patients taking certain types of blood pressure pills.  Differences in how people from various ethnic and racial backgrounds respond to medications is one reason minority advocacy organizations are resisting the push to launch more comparative effectiveness studies.

The Congressional Black Caucus expressed concern that “comparative effectiveness research will be based on broad population averages that ignore the differences between patients.”  While House and Senate negotiators inserted language in the final bill requiring government-funded trial to include adequate numbers of minorities (and women), some are still concerned that this isn’t enough.

The issue of differences in how people of various racial and ethnic groups respond to medications was a major topic of the interview series I conducted a few years ago focusing on race and medicine.  You can read one scientist’s comments about this issue here.

This week, the New York Times and other outlets reported that Bayer has taken the rare step of producing and distributing corrective advertising for its Yaz brand name birth control medication.  Yaz is indicated for the prevention of pregnancy, management of moderate acne and premenstrual dysphoric disorder.  Bayer produced an advertisement that the FDA requested be removed because viewers could interpret it to mean that Yaz helps women remedy a larger array of acne symptoms and can help treat PMS.

The Times reported that the FDA and a group of states attorney generals forced Bayer to spend $20 million to air a series of commercials correcting the record and stating that the company’s previous advertisements were “unclear.”

John Mack who writes the Pharma Marketing Blog wondered if Bayer “shouldn’t use its power” to ask an actress (Desiree Hall) who appeared in the TV commercials to remove the advertisement from YouTube.  It is worth mentioning that Hall has also published a number of her other commercials on YouTube, indicating that she is using the Website for self-promotion.

Based on my understanding of FDA regulations, unless Hall was acting as an agent of Bayer when she posted the commercials, the drug firm has no responsibility or obligation to ask her to remove the spot.  Although Bayer employed Hall, the company does not have direct or indirect control over the content Hall chooses to upload to YouTube.  Of course the situation would be a little bit different if Bayer (or one of its agencies) had uploaded the video to to the video sharing Website.

In the end, it all comes back to control.  If a drug firm is responsible for the social media content, then the relevant marketing regulations apply.

With increasing numbers of manufacturers and retailers recalling peanut-containing products such as peanut butter daily, it is very difficult for consumers to figure out what foods to avoid and how the government is responding.  Now, the CDC and its sister agency the FDA, have turned to social media to help quickly disseminate information about the various recalls.

For example, tomorrow, the CDC will be holding a Webinar specifically for bloggers designed to “give blog writers the chance to speak with FDA and CDC subject matter experts about the Salmonella Typhimurium outbreak efforts and future resources for bloggers during food safety incidents.”  This is an important step, as bloggers often spread the word about health news items and have a broader reach (via social network and search engine effects) than traditional media publications.

The blogger Webinar is very interesting and I encourage those interested in learning more about the peanut recall and the government’s evolving crisis communications strategies to attend.  It will take place tomorrow February 3 from 2:30 – 3:30 p.m.

As previously discussed on this blog, yesterday my firm Envision Solutions released an extensive report and produced an in-depth Webinar focusing on health social network communications.  The session and report (Achieving Openness: The Art Of Listening, Learning & Communicating With People Using Social Networks For Health & Wellness ) are now available for download.

This extensive (60 + page) free publication features:

– Information about four major communications strategies health
organizations are currently using to engage with social networkers.

– New data that will help health industry executives predict the impact
of two-way dialogue with social network users.

I want to take a moment to thank Inspire, CDC, TNS Media Intelligence Cymfony, Sermo, PatientsLikeMe and Ignite Health for participating in the Webinar and providing commentary for the report.  To listen to the Webinar and download the publication, please click here.

Image Source: The New York Times

Image Source: The New Yorker Magazine

This morning on my train ride into the city, I read an excellent essay by Atul Gawande focusing on health reform that was published in the current edition of The New Yorker.  He rightly suggests that health reform is going to ultimately build on the system we currently have – even though it is far from perfect.  He writes:

“Many would-be reformers hold that “true” reform must simply override those fears. They believe that a new system will be far better for most people, and that those who would hang on to the old do so out of either lack of imagination or narrow self-interest. On the left, then, single-payer enthusiasts argue that the only coherent solution is to end private health insurance and replace it with a national insurance program. And, on the right, the free marketeers argue that the only coherent solution is to end public insurance and employer-controlled health benefits so that we can all buy our own coverage and put market forces to work.

Neither side can stand the other. But both reserve special contempt for the pragmatists, who would build around the mess we have. The country has this one chance, the idealist maintains, to sweep away our inhumane, wasteful patchwork system and replace it with something new and more rational. So we should prepare for a bold overhaul, just as every other Western democracy has. True reform requires transformation at a stroke. But is this really the way it has occurred in other countries? The answer is no. And the reality of how health reform has come about elsewhere is both surprising and instructive.”

This article is wonderful because it is pragmatic and it relies on a nuanced and informed grasp of history to inform predictions about the future.  This is a must-read for anyone interested in pragmatic, doable health reform.

According to the National Alliance for Caregiving and Caring.com, 50 million Americans are providing unpaid health care to family members and other loved ones.  Given this, they have asked President-elect Obama to direct 1 percent of dollars from the economic stimulus package now being debated in Congress to these individuals.  A press release distributed by both organizations notes:

“While the deteriorating economy has hit all Americans hard, it has hit these Americans even harder. Family caregivers are struggling to pay their own bills and, increasingly, those of their loved ones as well; expenses continue to rise and the hours of care they provide each day continue to go uncompensated. The average caregiver spends $5,534 per year out-of-pocket for caregiving expenses.  Like Wall Street, the auto industry, and homeowners, family caregivers need help from Congress to make it through 2009.”

Both organizations have developed five priorities they would like federal elected officials to act on, including increasing funding for the National Family Caregiver Support Program and developing a national paid family medical leave program.

For more information about the campaign and to provide suggestions on how to improve support for caregivers, please click here.