Best strategic learning investment in 2010?

December 23, 2009

I was honoured to be asked to contribute to this ebook of essays edited by Ellen Hoenig Carlson, which she has kindly invited me to share with you here:

I’ll be interested to hear what you make of it. Do please leave a comment here in order that I may collate feedback for Ellen in order to make our next publication even better.

That’s it for 2009 from me.

I look forward to listening, learning and laughing with you in 2010.

Health and happiness to you and yours for the coming year.


What pharma can learn from communities’ opinions

December 22, 2009

On 7th October, one of the administrators of TuDiabestes, the popular community for PWD (people with diabetes) asked: ‘Do you see a role for support staff from pump/meter companies here?‘. They went on to explain that they had been approached by ‘a major pump company’ and been asked if they would ‘consider allowing a non-sales oriented Clinical Manager to enter [their] community to answer questions about their products.’

Acknowledging that they saw both ‘potential pros and cons’ in the proposal, they went on to ask their community what they thought of the idea:

What do you see? Would you feel comfortable knowing you had a contact here to ask questions of? Would you feel less comfortable speaking freely about your experience or frustration with devices or customer service? Would you feel implicitly marketed to? Would you appreciate the chance to communicate with a representative who could troubleshoot your customer service issues?

The response the question provoked was consistent with the sort of attitudes that you would expect a community that manifests a high level of trust, mutual respect and transparency to manifest. Here are some sample reactions:

I think it may be a good idea. Like you said, as long as he/she was not trying to persuade a purchase in that pump type. It would give people a way of asking pump questions that are thinking of pumping or having a pumping issue. Nope, no problem here. (Respondent: Cathy)

If the individual is properly identified as representing the company, I’m all for more dialogue. As long as the individual has an “I’m paid to participate” tag and is featured only in a special section or during a live event. To me, that’s what marks the true distinction between passionate participants with personal investment in the community versus paid-for participants (who may be passionate, also, but reimbursed in some form). Let’s not kid ourselves. Many people on social networks are subtly marketing themselves–whether to promote their blog or website or fund-raising efforts, etc. That’s not a bad thing. But loyalties should be clear. (Respondent: Kelly Rawlings)

What I see here is the idea of using communities[...] as another channel through which to provide customer service and support. (The “call center” of ten years ago is more often the “contact center” of today, including phone, e-mail, web chat, company-sponsored forums, and sometimes direct-connect-to-device channels of communication with the customer — which can be a win-win situation[...] As far as being afraid to post something negative about the company… well… they can read everything we write here whether or not they are members of the community, so the only difference is having a contact with a name and a position. (Respondent: tmana)

What makes Tu and other user driven networks special and useful is that we are sharing with each other our unique perspectives as patients and support systems for patients. I am sure they could provide technical data and keep our community informed… maybe finding a specific way for them to do that without participating like members may be more appropriate. Maybe special forums for product updates, Q and A’s, etc. I suspect they are already here in some form. Good idea to make it more legit and up-front. (Respondent: Patricia)

I welcome them to provide both insight AND to understand how their products are truly perceived and used in the hope that this will lead to better tools. I would not restrict them to posting in any forum as long as they are identified as you have noted. After all, many of these folks are diabetics…. and they are people too :) ! My guess (and hope) would be that their companies are going to restrict how they post. As in many other forums that I participate in, the good ones quickly become identified and the bad ones do too. (Respondent: Mike Ratrie)

I found these replies of interest on a number of levels, but the thing that perhaps struck me most strongly is the way in which these online community members have strict expectations with regards to openness, honesty and transparency, but upon commercial invitees manifesting what are effectively the preconditions of participation will go on to offer not only their conditional acceptance but also understanding and a desire to empathize with them. If you turn up with open hands, until you let them down they will be prepared not only to interact with you, but also to support you. After all, ‘[you] are people too’.

To me, this is an example in miniature of the characteristic benefits that fully participating within social media environments can confer upon those who are prepared to be authentic, open, and transparent. The quality of engagement that the responses above demonstate suggest to me that the TuDiabetes community would be prepared to offer instrument manufacturers who were invited into their community and deported themselves in an appropriate manner would far outweigh those resulting from the sort of interactions we would perhaps previously have categorized as ‘marketing’.

This is what contemporary marketing looks, sounds and behaves like.

It doesn’t heed your command.

It observes the precepts of a conversational economy rather than a transactional economy.

It generates respect and enhances reputation directly; it generates revenue indirectly.

It has the potential to give back to the bestower more than they could possibly expect to receive in non-financial terms, and consequently support their revenue-generative activities in the long term in ways they could not have anticipated.

How is it facilitated?

By treating people as potential friends rather than potential customers.

If all this sounds a little too ‘new age touchy-feely’ to you and correspondingly lacking in the hard-nosed commercial dynamics you may have been schooled in, that’s fine. We are all at liberty to go and stand in a corner by ourselves, alone and unheard, and feel superior.

An enduring flaw of perception manifested by those who have not yet managed to escape the hermetically sealed confines of the traditional pharma marketing environment is the opinion that there is a set of Universal Protocols that function effectively in every context.

What social media is beginning to reveal is that these protocols may never really have worked in any context. Furthermore, the indviduals at whom the campaigns were directed may never even have noticed them. They did not make decisions based upon the succinctness of strap lines they never read, the zaniness of commercials they never saw, or the draw of radio spots they never heard.

We may once have rehearsed a narrative in our monthly, quarterly and annual reports personifying our marketing activities as heroic protagonists represented in the metrics and bar charts of our our creation. We were universally acclaimed, professionally applauded influencers of actions and opinions. We knew this because the focus group audiences that we paid to listen to us told us so.

It never crossed our minds that in the last instance the independent decisions regarding our products taken by the 95% of recipients who neither registered for nor responded to our campaigns may actually have been a better indicator of our enterprise’s success than the 5% who did.

A relationship that takes on a material form is enduring and open-ended.

A transaction that becomes a sale is transient and finite.

The former has a future; the latter is being consigned to the past.


The pachyderm in the parlour: resisting the legitimation of DTC social media activities in Europe

December 14, 2009

Last week, my #hcsmeu co-founder and collaborator Silja Chouquet offered a great summary of some of the reasons why those who take an interest in health care in Europe must guard against modeling their own activities in 2010 along the lines of those that were undertaken at the FDA social media hearings in Washington last month.

I won’t repeat the post’s observations and conclusions here, but if you have yet to read it, please do so now. Silja, myself, and the Health Care Social Media Europe community will have a lot more to say about this in the months to come.

Instead, I will conjour up a symbolic pachyderm that may like nothing better than to settle itself in Europe’s parlour by asking a question that was not raised in Washington, namely: is it appropriate that pharma should be allowed to use direct to consumer (DTC) messaging within social media environments at all?

Regardless of whether they facilitate ‘1 click away’ access to fair balance and safety information, ‘improve’ patient safety through the use of a mooted adverse event reporting widget, or create a collaborative framework for patient interaction, from one perspective the FDA hearings were little more than an attempt to legitimate DTC advertising within social media environments without having debated whether they should be allowed to do so in the first place.

There is a fallacy of intention at the heart of the proposition that pharma marketers have a de facto right to conduct themselves within global social media environments in the same manner that they have traditionally done within broadcast media in the USA, and that the outcome of the FDA hearings must of necessity be viewed as a means of discerning how, rather than why, regional DTC marketing should be undertaken within the flourishing global patient and consumer communities that have been brought together by social media.

Would a ‘1 click’ rule help patients make better health decisions, or would it provide the pharma industry with better targeted advertising opportunities?

Would an adverse event reporting widget improve safety for patients, or would it reduce the risk of litigation for pharma?

Would a collaborative framework enhance intra-patient and/or patient-health care professional interaction, or would it afford pharma the opportunity to inveigle itself into a conversation it is danger of being shut out of?

The European pharmaceutical industry would probably also like to pass immediately into an arena wherein interminable discussions will be held as how it could conduct its marketing activities within social media without having first scrutinized whether it should be allowed to do so as a first principle. In order to prevent this conceptual segue taking place, I would favour coaxing our elephant from the parlour to the portico: from the space within which the debate is being held, to the entrance that it would symbolically block. At least we would then be able to have a discussion as to whether it should be allowed in through the front door rather than being shooed in through the back way.

Whilst there are any number of justifiable conversations and sanctionable interactions that the pharma industry could rightfully expect to be able to productively engage in within social media, DTC advertising is not one of them.

To my mind, DTC advertising has no place in European (and therefore by the necessity of extension, global) social media. It is critical that the global – not just American – patient communities who have been largely excluded from the debate until this point should be making their voices heard in this regard by contributing to the commentary that the FDA is currently collating, as well participating in the survey that John Mack is running.


Seeing health issues through Google Goggles

December 11, 2009

Take a couple of minutes to watch this:

Then contemplate whether these have a future.

Aside from the visual identification of drugs, Jessica Seilheimer has suggested Google Goggles has the potential to identify skin infections as part of its serving as an authoritative guide to a wide range of self-diagnostic questions that have unequivocal visual signifiers.

Google Goggles allows users to take photos that are then scanned by the application, and searched. Ideally, those searches would be ranked in order of relevance to resolve scanned images of skin conditions scanned to high quality evidence-based results such as those contained within Evidence-Based Medicine Guidelines. The latter contains dermatological disease images, electrocardiograms, retinopathic pictures, and a variety of visual diagnostic aids.

It is relevant, reliable, timely, but not unfortunately not accessible unless you happen to have a license. It’s a shame that content that has such an immediate and obvious application is locked away behind a paywall rather than facilitating access to high quality health information for the 85% of online Europeans in the United Kingdom, Germany, France, Italy, and Spain who now turn to the Internet and other technologies for health and prescription drug information, as well as those seeking the same everywhere else in the world.

To what uses do you think Google Goggles could be put in healthcare?

Thank you, Phil Baumann, for being the first to bring this great new application for Android phones (sorry, iPhone owners) to my attention.


Citemine: preparations for the publish:filter revolution have begun

December 10, 2009

Citemine is a new platform that gives us a glimpse of what peer review might look like after the publish:filter tipping point has been reached.

As with any foot-tapping, clock-watching armchair punditry concerning when we can expect a revolution to occur, the launch of Citemine doesn’t offer any answers. What we can say, however, is Citemine’s existence takes us a step closer to its instantiation.

The publish:filter revolution has begun.

Citemine’s creators offer a summary of the principles that led to the creation of this clean, simple reputation-driven peer review facilitator :

We believe that peer review should be fast, that reviewers should be accountable for the ratings they assign to papers, that good research should gain recognition quickly, and that if quantitative measures of research performance are to be used, that they should be responsive, leading (as opposed to trailing) and unbiased towards particular classes of researchers (for example, more experienced researchers).

I have participated in many discussion during the last twelve months concerning what a click-to-rate (think: digg) academic peer review appartus would look like. Here’s Citemine’s take on the process:

  1. Sign up. Get reals.
  2. Spend your reals by submitting manuscripts or buying a stake in someone else’s manuscript.
  3. Gain reals when someone cites a manuscript that you hold a stake in or when you sell your stake at a profit, including the stake you hold in your own papers.
  4. Lose reals when you sell your stake in a manuscript at a loss or when you submit a manuscript that nobody thinks will be cited.
  5. It’s peer review, but not as you know it!

Honestly, I’d have preferred it if Citemine hadn’t conceptualized a community’s assessment of the repute in which a scholarly publication is held in economic terms, but my semantic quibbles do not alter the fact that this is a powerful tool that could affect the sort of change to the peer review process that has been widely debated concerning a means of bestowing community approval upon research.

Content is published (think of it as having the status of a journal’s blog post at this point), considered and rated by a community, and having attained a certain level (how that would be defined remains moot) of acceptance, is considered to have been formally published. Alternatively, leave out the two-stage process altogether (which I’ll concede to being conceptually aligned to the journal model of publication, which need not persist) and simply deploy strong subject filters in order to help users find, read, and rate content.

What do you think would happen if PLoS or BioMed Central experimented with a Citemine-like functionality within their platforms?