The Top 10 Health Stories of 2009

When it comes to staying on top of the collective news cycle, accurately tracking and knowing the stories that prompt conversation is the key. Being connected to the audience and their interests is impossible without an understanding of what has mattered in the past.

Health reform on Capitol Hill, the H1N1 virus, breakthroughs in cancer and obesity research, and the merging of Pfizer and Wyeth into the world’s largest pharma company were all big news in 2009.

While several organizations have done a nice job of synthesizing the top issues driving healthcare news coverage this past year (Harvard Health Letter, Time Magazine), our Media and Technology group went a step further to examine the exact articles that had the greatest impact online.

Starting from a list of more than 500 news articles and blog posts, WCG developed a simple algorithm to zero in on the Top 10 stories from 2009.  The ranking, highlighted below, considers factors such as the number of websites that link to an article, how many people commented on it, how broadly it was disseminated in Twitter and top social bookmarking sites, and how many websites referenced the article’s headline.

We look forward to discussing with you more about how we arrived at the Top 10 and using similar analytics and approaches as we continue to innovate new ways of analyzing what drives influence online.  Please use the Comments section below to add your thoughts.

Top 10 Stories of 2009

 

Rank	Index*	Headline	Author	Outlet
1	100	House Democrats pass health-care bill	Lori Montgomery and Shailagh Murray	Washington Post
2	59.36922	Why We Need Health Care Reform	Barrack Obama	NY Times
3	56.66738	Obama signs massive, 'imperfect' spending bill	Danny DeFreitas (Deputy Editor)	MSNBC
4	48.59569	Congress Slams Panel for New Mammogram Guidelines	John McKenzie and John Parkinson	ABC News
5	42.31632	HIV/AIDS: The incurable epidemic	Fred Hiatt (Editor)	Washington Post
6	34.41015	24 hours in the ER' shows challenges of health system	Susan Page, Marisol Bello, John Fritze, Mary Brophy Marcus and Liz Szabo	USA Today
7	34.22327	WHO raises pandemic alert to second-highest level	Vital Signs Blog--Contributors Dr. Sanjay Gupta and Barbara Starr	CNN
8	28.60779	Senate Blocks Use of New Mammogram Guidelines	David M. Herszehorn	NY Times Prescriptions Blog
9	27.43842	New guidelines: Pap smears can start at 21	Julia Sommerfeld (Editor)	MSNBC
10	18.03716	Obama Ends Stem Cell Research Ban	CBS News	Associated Press

*Index: the measure that defines the relative impact of each article when compared with all of the articles collected from 2009; This is the final output from the algorithm describes above. This list brings to life the common concerns and interest of the broad healthcare audience. This ranges from the average person who simply keeps up with the news to the top health industry executive who never stops monitoring the issues. Now, what will the focus be in 2010? It’s impossible to know, but I leave you with the proof that news flow matters and the stories the audience chooses are what drives it.

Perspective on the FDA Social Media Hearing

 The FDA has completed a two-day Part 15 Public Hearing titled “Promotion of FDA-Regulated Medical Products Using the Internet and Social Media Tools”.  A total of 76 presentations were heard by a packed room and large webcast audience.  This phase of the public hearing will continue until February 28, 2010, which is the last day to submit public testimony.  The current thinking is that guidelines could emerge as early as Summer, 2010, although no formal commitment to a timeline has been given.

The tenor of the presentations was quite clear.  It is time to figure out how manufacturers can engage directly with customers online.  This was a nearly unanimous theme.  On the flip side, very few solutions were offered at this time.   And as Tom Abrams, Director of DDMAC said, “conversations are enduring and seen by millons”, so we need to figure out how to engage in the right way.  

So, out of 76 presentations, here’s a “cut through the clutter”.  Part I addresses key questions discussed of importance to future guidelines.  Part II reflects how the world has changed and why guidelines will need to account for these market changing developments.

Part I

#1 – If you correct information online, are you responsible for the full conversation?  -- Speakers made the point that companies cannot be held responsible for every comment made on every site worldwide.   However, it is important for companies to be empowered to correct information on third-party sites in a conversational style and continue to monitor those sites to see if a 2^nd or 3^rd comment is warranted to provide further clarification.  In other words, the future will be about how to monitor and engage selectively and effectively to ensure the right benefit and safety info is available online.

#2 – What is the Most Effective Way to Share Safety Information? – I don’t believe anyone is defending the current approach of mentioning side effects at the end of a TV commercial or clicking to highly detailed, hard to read information.  Rather, in today’s world, we have an opportunity to display safety info online that is easier to read and navigate before the first click.  The good news is that the web makes it much easier for us to create the right experience. 

#3 – Current paid search ads suffer from lack of clarity and lack of conversion – data shows that when you understand upfront what is being advertised, click conversion is higher.  Many of today’s ads require you to click to find out more, since the upfront ad is not clear enough.  Conversion goes down.  FDA was encouraged to work with companies to make it possible to have more transparency upfront. 

#4 -- How much identifiable criteria must be there to report an AE? – several people pointed out that the current MedWatch form for AE reporting to FDA is onerous.  Others discussed how few AE’s exist online vs. the total online conversation.   The conclusion is that current AE reporting mechanisms need to modernize and be simplified.  We also need the guidelines to clarify what a company’s obligations are as they further engage in conversation online.

#5 – Why extending a brand’s reach is linked to extending monitoring – if companies want to reach a wider audience online, then it’s important to conduct monitoring of a wider audience online, as well.  The two go together.   Responsibility for monitoring widens as your reach widens.

#6 -- Companies are responsible for communications they create or cause to be created – if a company has a hand in the creation of content, it’s responsible.  The presentations centered more around defining this from a financial standpoint. 

Part II

How the World Has Changed

As the FDA considers new guidelines, here are examples of how the marketplace has changed. 

#1 – Communities self-regulate effectively – online communities look out for the best interests of the community and self-regulate.   They are often the best at correcting information.  One example at the Hearing was VU-MEDI, a community for 10,000 surgeons, which provides a continual review more comprehensive and quicker than a typical peer-review process on new surgical procedures.

#2 – We don’t live in a simple one-click world – people search for the information they need/want and links are a critical part of the learning process.  It is normal to click horizontally for broader info or click vertically for deeper info on a given topic.  We don’t control a person’s search.  But, we can provide them with the most options on how and where to learn via clicks. .

#3 – Search now forms the first impression for a brand – where are your customers going for information about your brand, whether it involves benefits or safety info?

#4 – Offline/Online synergy is increasing – ComScore showed that 52% of people who see an offline campaign search online for more information.  This integration is becoming standard for our customers.  

#5 – The importance of peers -- Customers increasingly look to peers for advice.  They don’t need companies in the conversation to make a decision, but they would like companies to participate, which was clear in the surveys shown this week.  Companies and brands that are part of the full conversation will build trust and will be considered relevant to decision-making.  The same comment applies to the FDA.

#6 – Old-style websites are decreasingly relevant -- it is content syndication that matters, not traffic to a site.  The FDA will need to adjust what they require of websites to meet the new reality of how people utilize content, so content can be more easily shared.  

#7 – The importance of the “core community” – Customers will often spend their days in their core community.  Think of Facebook.  All the more reason why we need the ability to reach people in their communities, rather than asking them to visit our sites, which they may never do.

 

#8 – We can improve the reach of safety information – we can extend a brand’s safety information online simply by participating in forums, Yahoo! Answers and other parts of the web where we share approved FAQ’s and other related safety information.   When you combine with a strong SEO plan and knowledge of the right keywords, a brand’s reach can be extended widely with time.

#9 – The future is not with closed communities -- closed communities complicate the ability to publicly share information.  They prevent the syndication of important and relevant content.  Place more time on open communities when possible. 

#10 – Physician and patient influence is changing – we are seeing more physicians proactively utilize the web to find patients and share information.  At the same time, patients with the most influence may not be affiliated with a patient group.  They will be affiliated with great content and a loyal online audience.  Our customers are becoming more saavy online every day.

Overall, social media guidelines will require industry to provide innovative solutions to the FDA and for the FDA to create guidelines that can evolve with the medium, rather than place increasing constrictions on it.

All the best, Bob

The FDA, Swine Flu and Twitter

It used to be that the public found out about FDA approvals in a relatively straightforward way: the wire services would tell them, either because the company involved pushed out a press release or the FDA did. It was a great example of the old-fashioned news flow: newsmaker to media to public.

That's a system that is breaking down in the age of text messaging and Twitter, and another FDA approval -- this time of the new swine flu vaccine -- illustrated that brilliantly. At about 1 p.m. on Sept. 15, the Secretary of Health and Human Services, Kathleen Sebelius, was giving her opening statement at a House of Representatives committee meeting. There was nothing in her prepared statement that suggested there would be anything more than an update on the current swine flu planning, but not long after Sebelius started speaking, she dropped a bombshell: the FDA had cleared the swine flu vaccine.

Because the committee meeting wasn't packed with FDA reporters, the new trickled out slowly. at 1:37 p.m., Rep. Greg Walden broke the news, hammering a tweet into his BlackBerry: "Participating in hearing on H1N1 flu with Sec Sebelius. FDA has just approved four more vaccine producers. Go to http://www.flu.gov for more info."

By the end of the hour, the first wire story had appeared, from the Associated Press. But into today's fragmented media world, a single AP story didn't have immediate impact and questions began to swirl. It's not the wire services that carry the world's most up-to-date news. It's Twitter.

"FDA has approved the swine flu vaccine, but no details yet. Lemme know if you seem 'em before I do," tweeted Scott Hensley, the veteran health reporter now at NPR, at 2:26 p.m. CNBC's Mike Huckman had jumped on the case, informing his followers at 2:37 p.m. "Sebelius told Congress apparently. Told FDA working up PR now." Nine minutes later, he had more confirmation: "Sanofi-Aventis $SNY confirms FDA has approved its H1N1 #swineflu vaccine. AP reports FDA has also OK'd AstraZeneca $AZN & Novartis $NVS vax."

Even two hours after Sec. Sebelius made the news, journalists were still hunting down details. At 3:09 p.m., the Baltimore Sun's dependable Kelly Brew was still seeking out info, keeping her followers up to date: "hearing reports that a swine flu vaccine has just won FDA approval.. will keep you posted."

By the end of the day, the FDA and company press releases were out, the story was being told, and order had been restored to the media universe. Still, there was no official government word of the approval on Twitter until nearly 8 p.m., when the flu.gov's Twitter stream carried a link to the FDA press release.

What's remarkable is where the tweets didn't come from. The FDA's new "drug info" Twitter account carried no news of the approval. And despite the fact the two of the four companies whose vaccines were cleared are on Twitter, there was nary a tweet on the subject from AstraZeneca or Novartis.

The point isn't that the old model of news distribution is hopelessly antiquated (it worked just fine on Friday, with two FDA approvals reaching the public using the usual pathway), it's that there are a lot more channels to think about, channels that the media are already relying upon for their newsgathering. For huge and growing numbers of newshounds, Twitter is their primary information source. As the flu approval demonstrated, a lack of engagement on Twitter means -- quite literally -- missing the story.

The 5 Myths Surrounding the FDA and Social Media

The last time the U.S. Food and Drug Administration gathered information on how it ought to regulate medical information on the Internet, it was 1996. Google wouldn't exist for 2 more years, and Facebook founder Mark Zuckerberg was 12 years old.

That is all about to change. The FDA will, in mid-November, hold a hearing to get comments from the public on a huge list of questions as the agency considers whether to revise its approach.

Given the silence from the FDA about the rules of the road for online communication, this has been greeted with breathless excitement by FDA-watchers (the Federal Register notice is a "must-read," read one early comment on Twitter. "Nothing less than astounding," gushed a blogger). And while the hearing will no doubt be looked back upon as a turning point in term of FDA rulemaking, there are a number of myths worth dispelling about where the FDA is headed:

Myth #1. The FDA Cares About Your Opinion: The 2-day hearing is going to be packed with speakers offering their own expert opinion on what the FDA should do. It's entirely likely that those people will be entirely ignored by the agency. They care about data, and they ask participants to show "data" or "research" more than a half-dozen times in announcing the meeting. (They are also curious about real-world experiences.) If you have information about how users seek health info on the web, the FDA is going to pay close, close attention. The best example of this is a presentation by Duke's Ruth Day in 2005, in which she offered a study that showed that distracting imagery in drug ads inhibited comprehension of risk information. Earlier this year, the agency tightened drug ad rules specifically citing ... distracting imagery.

Myth #2: FDA is Ready For Wholesale Change: In announcing the meeting, the agency suggests that its current approach -- that it is in the business of regulating the message, not the medium -- remains a useful tool for dealing with a whole range of issues on the Internet. And while its clear that there some areas in which their it's-the-message framework starts to break down, the hints in the meeting announcement is that they're looking to patch holes, not change the game.

Myth #3: New Rules Are Right Around the Corner: The meeting might be happening soon, but there is no indication that the FDA is going to move with any kind of speed. They'll take comments until the end of February and then will have to sift through what is bound to be a mountain of information. Perhaps they'll get around to issuing some targeted guidance by the end of 2010, but it could well be closer to 2 years before what gets said in November is fully digested by the FDA. Remember, it was 4 years between Day's presentation and new FDA rules.

Myth #4: The Agency is Taking a Hard Look at the Adverse Event Rules: From all indications, the agency feels pretty comfortably with its rules about what side effects need to be reported. What they don't know is exactly how industry is approaching the issue. The questions the FDA is asking around adverse events makes it sound like its trying to pull the curtain back on what pharma is actually doing, not change the rules of the game.

Myth #5: Industry is the Only One with Skin the Game: The FDA's questions hit the topic of transparency a lot, opening up the intriguing possibility that, even if rules are loosened, third-party groups are going to have to be a lot more explicit about where the funding and other support for their online initiatives are coming from. While unrestricted educational grants and unbranded campaigns have become popular ways to engage online without crossing the FDA, anyone that touches industry may soon be forced to think hard about relationships -- however tenuous -- with regulated industry.

Why the Big Guns Aren't Moving the Needle on Health Reform

Early in President Obama's address to the joint session of Congress yesterday, he underscored how important reform was to those intimately involved in health care: "Our overall efforts have been supported by an unprecedented coalition ... even drug companies, many of whom opposed reform in the past." His point was clear. The health care system was fraying so dramatically that all stakeholders -- even big pharma  -- had to be in the reform camp.

He didn't have emphasize drugmakers. He could have spoken about the support of the American Medical Association, which is in favor of current legislation, or even insurers, who have largely sat on their hands during the debate despite being routinely vilified. One of the elements that makes the reform effort of 2009 different from attempts in 1993 or 1965 or 1952 is that the big interest groups, for the first time ever, are on the side of change.

Given that these groups are credited with deep-sixing nearly every effort at comprehensive health reform over the past century, it would stand to reason that reform bills should skate through Congress without such hurdles. After all, big business isn't throwing millions of dollars of TV ads to undercut the president this time around.

And yet the talking heads after the speech made clear that reform prospects remain precarious and that this is a numbers game now for the president. Can he hold Democratic votes? Can he nab a Republican senator? Two?

So if the big interest groups aren't the ones making this a nail-biter, who is? As it turns out, it's a collection of a thousand (or million) politically driven interest groups, many of them using media that didn't exist 18 years ago to get out their message. Some of it is the Internet, which has made both pontificating and organizing easier than ever, some of it is the explosion of 24-hour cable news. And some of it is the use of technology to make all sorts of old tools, from direct mail to canvassing, smarter and more effective.

The point here isn't to decry the echo-chamber effect in which we only hear the news we want to hear, from ideologically "safe" sources. (Though that it worth decrying.) It's to illustrate how good at transmitting messages the ideological warriors on both sides of the health issue (and, indeed, any political issue) have become, especially in contrast to health companies, who are just now dipping their toes in social media waters. In 1993, Harry and Louise and a boatload of national airtime could effectively steer the debate. Now, shaping the discussion is far more complex. Opponents of reform understand that. The unresolved questions are whether the health care industry -- patients, doctors, executives, researchers and scientists -- understand the new reality, and whether they can adapt to it quickly enough to salvage reform.

Getting Beyond the Avatar: How Roche Did It Right

There is a tendency to judge a the social media savvy of biopharma companies by simply tallying the sum total of their online presence. Got a Twitter feed? A You Tube channel? Great: you're in the top tier.

But simply hanging a shingle in the more genteel corners of the social media doesn't automatically mean translate into influence or eyeballs. A couple hundred subscribers to a YouTube channel falls somewhat short of a revolution. That's not to say that incremental progress isn't important. Nor does it mean there aren't folks out there who aren't making waves using these tools. Take Kevin Pho, an internist in New Hampshire, who has turned his oft-updated blog into a daily must-read for thousands and garnered a regular spot on the USA Today op-ed page. That's the world we live in today: one doc, posting in his spare time, has an online footprint that dwarfs most Fortune 500 companies.

It's not breaking new ground to suggest that companies should take some time getting to know these new influencers; tech-forward companies have been doing it for years, and health care giant Johnson & Johnson has gathered a handful of bloggers for dinner at least a couple of times.

But, this summer, Roche took a bold step in health care social media by bringing a couple dozen diabetes bloggers to their Indianapolis campus. This was a stroke of genius: diabetes has one of the largest and most cohesive online communities, a group of motivated individuals all dedicated the kind of constant vigilance need to thrive with diabetes. They enlisted the help of Amy Tenderich, who writes the site diabetesmine.com, and managed to bring a select and diverse gang to Indiana. There were leaders of online communities (Manny Hernandez), writers who looked at the business angles (Kelly Close), longtime online diabetes journalists (David Mendoza), and many, many more.

But Roche shouldn't get full credit just for flying folks to their confab for a song-and-dance routine. They listened. Especially when the assembled crowd started asking tough questions about the economics of diabetes test strips. Reading the blog coverage afterward, it was pretty clear that the Roche line on test strips didn't resonate with everyone. But that didn't matter: the company had heard them out, and that clearly generated oodles of goodwill.

And that's goodwill that's hard to come by through 140-character tweets or even the occasional corporate blog post. It's rare that Bob Pearson gets through a blog entry without extoling the value of listening, and it's worth remembering that -- even in a wired world, dealing with wired influencers -- sometimes it's easier to listen when you're sitting face-to-face.

Sermo, the AMA and the Rise of the Wired Physician

Of all of the dustups that the great Health Reform Debate 2009 has precipitated, none is as significant -- or as under-appreciated -- as the war of words between the American Medical Association and Sermo, the physician-only social network. Wherever the policy debates on the specifics of a health reform bill fall out, we'll still have much the same system that we have now, assuming the bill passes. Yes, more people may be insured. Yes, we may have an additional government plan. And yes, there will be changes around the edges. But we won't see the $2.4 trillion-a-year health care business reshaped beyond recognition.

What we will see, however, is a sea change in how doctors are organizing. And this is likely to lead to profound changes in everything from how doctors practice medicine to how physicians operate as public policy advocates.

Let me back up. Earlier this summer, the AMA and Sermo ended a two-year partnership intended to allow the AMA to plug into Sermo's logged-in physicians. Then the broadsides began: Sermo's founder, in early July, posted a blog entry that called the AMA "The Biggest Risk to US Physicians." Over the next three weeks, the social social network put out three separate releases that said that an overwhelming number of Sermo physicians rejected the AMA's stance on health reform and opposed the current versions of the bills under consideration, noting that three of four Sermo members were not members of the AMA and that nine in 10 didn't think that the AMA reflected their opinion of medicine.

It is likely true that the AMA's membership is larger than Sermo's, and there is no question that the AMA remains the official (and powerful) voice of the physician lobby. But Sermo's explosive growth and the site's demographic -- younger, Internet-savvy docs -- means that the tables will soon be turned and that what the community on Sermo thinks may represent the collective stance of the nation's doctors. And we probably won't have to wait long for this to happen.

Of course, having an influential group of wired doctors, unmoored from any formal bureaucracy is only the first step. It won't be long before online patient communities, too, become more powerful than the old-school advocacy groups that have long spoken for patients. Just take patientslikeme.com, where the future has already arrived in the form of hundreds of highly involved patients swapping detailed information about their disease and treatment.

These new groups don't mean that traditional patient- or professional-centered associations will cease to exist. But, increasingly, they will have to co-exist with raucous, minimally organized groups of incredible informed individuals. And in a new world in which connections are king and every opinion can be broadcast, this is excellent news. The more voices we can hear, the better.