Patient care is increasingly under third party control.  And as a consequence I make fewer decisions regarding the brand of medication used in my patients.

So the role of a pharmaceutical rep comes into question.  If I don’t choose which medication my patients will use, why would a representative call on me?  And as American medicine becomes more centralized and standardized, I wonder how and why industry will connect with treating physicians.  Pharma it seems is asking the same question: Of the core medications I prescribe, I see far fewer reps these days and our relationships are markedly different from a decade ago.

I don’t miss the pitch.  But I find the element of human support to be important.  For example, recently the FDA issued a black box warning for the concomitant use of Remicade and 6-MP.  My representative visited to be sure that I was aware of the changes in the product insert.  Sure the information was in my mailbox – along with 6 inches of pulp spam.  It’s basic attenionomics: I’m more likely to hear a person than a letter.

Going forward I suspect that our future encounters with industry will be more permission-based and contextual.  Pharma and medical device manufacturers will evolve to embrace a more open, social business design that cultivates a supportive rather than sales relationship with physicians.  I suspect that my information about these products will come from digitally facile humans who know me and understand how I get information.  Responsible doctors and industry professionals should open their dialog so that the social public can see that the conversations are properly centered on the patients.

While my political incorrectness may awkwardly quiet the room, I believe that providers should have some kind of balanced, transparent relationship with those who create the stuff that fixes our patients.  As medicine becomes progressively dependent upon advanced diagnostic and therapeutic technology, I might suggest that to avoid the discussion is irresponsible.

 

I can’t stop thinking about this:  Yesterday Vertex Pharmaceuticals reported early success with their new drug for cystic fibrosis, VX-770.  Designed specifically for the treatment of a specific mutation of CF, 6551d, it targets a defective protein critical to the disease process.  Patients showed sustained improvement in lung function.  There’s more work to be done here but there’s something to be said for what it potentially represents.

I was a medical student in 1989 when the first gene for CF was identified.  I remember reciting the location of the gene for the pediatric chief resident on rounds.  We were proud to be part of a field that was getting closer to understanding the root of such a devastating disease.  But my experience was much like that of doctors in the 19^th and early 20^th century, we could describe but there was nothing we could do.  The identification of genes just made us more reductive in our description.

VX-770 is not the first example of therapy designed and targeted to specific genotypes.  But perhaps what’s newsworthy is the fact that this wasn’t front-page news.  This is the way medical students are coming to see therapeutics. Targeted treatment is the way medicine will work in our generation.

I would encourage you to read Matthew Herper’s A Big and Dangerous Day for Personalized Medicine in yesterday’s Forbes.  Read between the lines and you’ll come a little closer to understanding the future of personalized medicine.  As Matthew says, “rare diseases are shockingly common.” And more we understand genetically the more common ‘rare diseases’ will become.

Food for thought.

If you like this you might pick up a copy of Thomas Goetz’s The Decision Tree.

 

It’s been an important couple of days for social health. This week marked the inaugural SXSH in Austin one day before the famed SXSW. A meeting of passionate social health thinkers, SXSH was an unconference that was as important in what it symbolized as what it offered. SXSH has potentially instigated the evolution of a core meeting for those interested in the role of online socialization in health care.  It’s success stemmed from the hard work of Shwen Gwee, Dana Lewis, Reed Smith and Tom Stitt.

Johnson and Johnson’s Marc Monseau called SXSH one of the best social media events he had ever attended (and he’s seen a few). And SXSH caught the attention of SXSW organizers who assembled a last-minute panel to discuss SXSH. Until now, health has been an afterthought at SXSW.

Looking forward I have a couple of thoughts:

Silos. The topic of social media and health care draws on a handful of interests. SXSH focused on providers, pharma, and e-patients. But based on preliminary feedback from SXSH and attendees at the ER 2.0 SXSW panel, mobile developers are listening and likely will play a pivotal role in the implementation of apps that really change (or ‘delta’ in the words of Jen McCabe) health behavior.

The insight and innovation of Greg Matthews of the Humana’s Innovation Center has brought attention to the role of payers in the health conversation. Toby Plewak, The New England Journal of Medicine’s Manager of Product Development, has amazing insight from his work bringing the world’s most prestigious medical journal into the social sphere. I had the opportunity to meet Tobin at SXSW and discuss SXSH 2011. He’s excited about attending and hopefully we’ll be lucky enough to have him as a speaker or panelist.

All of these stakeholders are important and deserve a voice as SXSH is defined.

Cross-fertilization. SXSH, by virtue of its relationship to SXSW, has at its disposal some of the greatest minds in interactive media. We should tap that resource. We should take advantage of the remarkabl talent populating SXSW and cross-train with non-health experts from other industries. This year SXSH had Rohit Bhargava at our disposal which brought us visible credibility and expertise.

Show me the thought leaders. SXSH could evolve as the core meeting of those who think and innovate in health and social media. This, of course, will require the presence of serious minds. Thinkers drive attendance and conversation. Attendance draws sponsorship. SXSH should also strive to elevate those who are quietly pushing the margin but don’t have the brand recognition of the space’s KOLs.

Is there a doctor in the house? While painfully slow to engage in any meaningful way, physicians should not be discounted. There are MDs revolutionizing the way health maintained and delivered. SXSH should give them a pulpit. And don’t forget about the next generation of physicians. They’re in line to help set the standards once physicians take a more visible role.

After SXSH, let’s make SXSW healthier. Based on the standing-room-only status at our ER 2.0 panel, the attendees of SXSW want to hear more. Those versed in social media and healthcare should work to create panels that help SXSW attendees learn from what we’ve worked so hard to understand.

I believe that at some point we’ll look back at the passion of those present at this year’s SXSH and reminisce how it all started.

I’ll see you in 2011.

 

The time is approaching when businesses will want to capture the eyes and minds of physicians in the social world. Throwaways and mailouts will give way to more current channels of communication. Friends in the health industry ask how they should connect with physicians using social media channels.

The rules really aren’t much different but here are a couple of things the consultants will never tell you:

I’m not on Sermo. While Sermo and Ozmosis may seem like obvious targets, physician specific verticals are tricky. The road to the successful physician network is littered with the skeletons of startups who went broke trying to capture our eyeballs. While its hard to ignore Forrester’s bullish analysis of services like Sermo, I don’t expect the enthusiasm to be sustained. Look to the next iteration of IMedExchange to possibly be a game changer in this area. Until then, the connectors who are going to get you where you want to go aren’t necessarily hangin’
with other doctors. They’re found in the wild.

We’re not talkin’ about pills. If you listen to physicians on social platforms you may be surprised to learn that we’re not always talking about medicine. Sure we chime in on healthcare reform and some are in it only to pimp their health sites and blogs, but the real conversations fall off center of traditional medical things. While it’s  possible that the next generation of physicians will to use social networks primarily for the dissemination of professional information, I suspect that the way to a physician’s heart and mind is through the everyday dialog.

Remember the Law of the Few. In The Tipping Point (and long before Twitter) Malcolm Gladwell wrote about The Law of the Few which suggests that “the success of any kind of social epidemic is heavily dependent upon the involvement of a few people with a particularly rare set of social gifts.” These few are referred to
as Connectors – those with a special gift for bringing the world together. Look for physician connectors. Listen to them and watch what they do. Most organizations fail to make the meaningful connections with the real medical influencers that bear fruit on the major social platforms.

Look at Scott Monty. The health industry doesn’t have to reinvent the wheel when it comes to connecting with someone like me. I have always asked: “Where’s the Scott Monty of healthcare?” When will United Healthcare or Pfizer replicate the success of Ford? It isn’t complicated. Watch Scott on Twitter. See how he connects. Get a sense of how he makes people feel. Watch where he speaks. And who ever heard of an automobile company appearing at SXSW to offer free rides? He had apparently.

A few healthcare socialites who are making great headway: Marc Monseau (Johnson & Johnson), Greg Matthews (Humana), and Lee Aase (Mayo Clinic).

“90% of social is just showing up.” I took a lot of heat when I posted this quote on Twitter a few months back. But I think there’s something to it. Everyone wants to believe that social success comes from deep, ‘meaningful’ relationships. These descriptors are relative in the virtual world. Social media isn’t rocket science and simple visibility has real value when you’re starting out. Find socially active doctors. Be present. Be real. See how things evolve.

We’re not there yet. Be wary of industry-driven surveys fashioned to make you believe the medical world is spending all its time on Twitter or physician specific networks. The numbers of physicians meaningfully engaged isn’t substantial at this point. That’s because we’re busy. Windows of online opportunity with physicians are narrow. Despite the digital idealism of Health 2.0, the art of medicine still involves one individual touching another.  And it’s hard to do that on Facebook.

As the next generation of wired physicians grow into positions of power, expect real online engagement to evolve as a meaningful avenue for interaction. Until then, scrappy, smart, creative strategy that genuinely understands and respects the behavior of the social physician will rule the space.

 

This was the year that Pharma disclosed the names and payments of their physician consultants. Look here for physicians speaking and consulting with Merck, GlaxoSmithKline, Lilly, and Pfizer.

Physician disclosure of conflict is important. It helps put a physician’s opinion and point of view into a context. Disclosure has long been the standard in the academic world. This represents the first time that such information has been made available to the general public.

But how will patients use this information and how will it affect care and outcomes?  Should patients flatly avoid physicians or others who have a relationship with a pharmaceutical company?  And should patients routinely screen physicians for conflict?

I don’t know the answer to these questions. I’m not sure patients know the answer to these questions. I suspect patients may not like the idea but would be willing to overlook a pharma connection when the reputation of the physician is impeccable.

Transparency is all the rage. Expect more. But I’m wondering how the average health consumer will practically process the information.