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Jun 24

I admit it. I often don’t act my age. Lately I’ve been listening to and loving the new Black Eyed Peas album The E.N.D. The first six tracks are downright addictive but track 13, Now Generation, is a great commentary on today’s youth and also a good reminder of the need for real-time marketing tactics to be included in the mix (whether you’re a health marketer or otherwise).

Popular music of course both reflects and shapes the society of its time. Take a look at these lyrics from Now Generation:

I want money
I want it want it want it
Fast internet
Stay connected in a jet
Wi-fi, podcast
Blasting out an SMS
Text me and I text you back
Check me on the iChat
I’m all about that h t t p
You’re a PC I’m a Mac
I want it..

Myspace in your space
Facebook is a new place
Dip divin’ socializin’
I’ll be out in cyber space
Google is my professor
Wikipedia checker
Checkin my account
Loggin in and loggin out
Baby I want it..

This is the now generation
This is the generation now


Jun 22

pewSusannah Fox, of the Pew Internet & American Life Project, has released her latest research report, “The Social Life of Health Information.”  With a survey conducted in Spanish and English, and a sample size of 2,253 adults, the Pew report is the definitive guide to the prevalence and practices of digital health consumers, or “e-patients.”

Everyone Is An E-Patient (well almost)
Not surprising but reassuring to those focused on the e-patient movement, the survey found that 8 in 10 internet users look for health information online and that number continues to grow. The use of traditional information sources remains static and 86% of adults talk to a doctor about their health conditions. This just indicates that being an e-patient doesn’t mean you aren’t a also a patient who uses books, doctors, friends, or other influencers.  The Internet has reduced the friction associated with access to information and socialization, but doesn’t replace other sources.

Many Read; Few Contribute (and that’s quite alright)
The Pew report shows that e-patients are more passive than active. While 41% have read someone else’s comments or blog, only 5-6% are posting online. This is just an extreme Pareto principle at work and can be seen in online groups as well as offline groups. How many people at a conference raise their hands and ask questions? Probably 5 out of a 100. How many church members volunteer to collect money or greet parishioners or bring in flowers for Easter? Maybe 5 of a 100. I don’t think that number will change, and I think that’s just fine. If 5% of all people with a certain condition contribute, that’s a lot of content and good sample size that should accurately represent the whole.

Few e-Patients are Joiners (but what about serious chronic conditions?)
One of the apparent losers in this study is online social networks, which would include Facebook health groups, private networks like CML Earth, legacy community email lists like ACOR, etc. In fact only 6% of e-patients have started or joined a health-related group on a social networking site.

But what I’m curious about, and don’t think the survey queried, is what percent of e-patients with serious and/or chronic illnesses have joined an online group. The total population of e-patients of course includes mostly healthy adults who may be using the Internet to check out flu symptoms, diet pills, or what the procedure is like for a vasectomy. No need to join an online group for these issues. But what percent of people with cancer join a group? What about people with ALS? Or chronic depression? My guess is that the percentage of “joiners” in these groups would be much higher.

Online Health Info Is a Major Influencer (so shift your resources marketers)
Health marketers and communicators everywhere should note that 60% of e-patients say their health query online influenced their treatment decision and 38% said it influenced even whether they should see a doctor or not. Whether you’re trying to engage people on the topic of H1N1 flu, diabetes, insomnia, cancer or anything else, you need to dramatically shift your time, energy and money to the web.

This is Just the Beginning (buckle up)
I’ve always viewed us as being at the beginning of a movement; the beginning of a swelling wave. And trends in wireless adoption and inevitable impact of age will be accelerators to the e-patient movement. Quoting the report:

Indeed, those with mobile access to the internet are more likely than those who have tethered access to contribute their comments and reviews to the online conversation about health and health care. And mobile access is on the rise.

Adults between the ages of 18 to 49 are more likely than older adults to participate in social technologies related to health. As younger adults face more health care questions and challenges, they may turn to the tools they have sharpened in other contexts of their lives to gather and share health advice.

We are at a point where broadband and mobile web are becoming ubiquitous, digital immigrants are aging, and Web 2.0 technologies are being refined. The signs of the e-patient revolution abound.

Soon we will be immersed in the Web 3.0, personal genomics will yield personalized medicine and the gamer generation will see signs that they, too, are mortal. The adventure has just begun…


Jun 16

fred eberleinWith over 25 years of IT experience working at power houses including Control Data Corporation and Oracle, Fred Eberlein comes to patient tools from the technology side of things. His flagship product is a patented, secure web-based approach to pain tracking and management. Fred splits his time between his clients in the United States and his development office in Hungary, and I interviewed him over a crystal clear phone line while he was working in Budapest…

Kevin Kruse, Kru Research: So when did you start ReliefInsite and what was your mission at the time?

Fred Eberlein, ReliefInsite: We started developing ReliefInsite in January 2005. But my interest in pain management started in 2000.  I learned back then that all the issues had been worked out in terms of protocols and logic for assessing pain, but as so often has happened in healthcare, none of this was put it into a digital form. As one who has spent his career in IT, this really amazed me.

reliefinsite11Kru:  You focus exclusively on pain management and pain tracking?

Eberlein:  That has been our niche, our strong point. If you look at our website you’ll see that it’s free for patients, and healthcare providers.  But as our focus is on developing customized branded patient diaries/trackers for industry clients - this is where our revenue comes from - we have spent little resource driving traffic to our site. That will change later this year when we introduce the ReliefInsite Community.

Over the longer term, with the website, we are giving it away to ultimately create that community and then be able to create research components of that, reports and other things from the system and that we will sell.

Kru: Unlike many other health 2.0 companies you seem to have a very practical view of business with an immediate eye towards revenues

Eberlein:  Well, we are very nimble and I watch all the pennies. My goal is to create a balance between the web community, the research reports, and then customized development; it should work nicely.

reliefinsite2Kru:  Can you give an example of a client who is using your platform?

Eberlein:  We developed the Rheumatoid Arthritis Symptom Tracker site ( for UCB which is currently unbranded. UCB just got approval from the FDA for their RA drug, Cimzia, which is also prescribed for Crohn’s disease. Now that the drug is actually approved we will go through a redesign to match the brand of the drug.

Kru:  Any lessons learned that you can share from you experience with your pain tracking site?

Eberlein:  You commonly hear PHR [personal health record] utilization being at 3% and our stickiness is an order of magnitude better than that, I am happy to say. But frankly I am not satisfied with it. I think one of the big challenges we face now with all this technology is making it part of the patient’s lifestyle and the providers’ process.

I have the benefit of seeing firsthand over the last few years how utilization works. I’ve seen what patients do, what physicians do, and I think you cannot make it simple enough, you can’t make it easy enough, you can’t make it fun enough.

Kru:  What comes next for ReliefInsite?

Eberlein: Technology adoption is a big challenge and things like the iPhone and mobile technologies in general are helping to break down some of those barriers. Mobile is definitely the future.

I think what we really have to be thinking about is bringing gaming into the equation, and how to integrate health tools into our lifestyle as much as we can. Of course that includes integration to biometric devices and other types of things, because the whole idea of monitoring should be pretty much non-obtrusive and invisible to the patient but, of course, with their consent.

Jun 11

Run, don’t walk, to YouTube and setup your own channel. Have a hospital? Set up a channel for your hospital. Have a drug? Set up a channel for your disease state. Trying to get people to wash their hands, or take Vitamin C, or get their blood pressure checked more often? Setup a channel.

Nielsen Online estimates that YouTube gets almost 100 million visitors a month, which puts it right up with Google and Yahoo as one of the top 5 most visited websites on the Internet. And it’s still growing fast.

jnj_youtubeClick over and look at the J&J channel on YouTube. Go ahead, I’ll wait until you come back… OK, you saw it?

In less than a year J&J has posted over 140 videos, and the top 20 most viewed have garnered a whopping 425,000 views. Additionally, they have over 1,000 loyal “subscribers” who are anxious to view new content as it’s broadcast (er, published?).

Unless you have a mega-brand that is driven by tons of expensive DTC TV ads, I’ll bet there are few product websites out there that get over 40,000 views a month. And when is the last time 1,o00 people asked to subscribe to your branded website?

Need more examples? The Mayo Clinic YouTube channel (with 365 videos) is a good approach for hospital marketers and of course I’ve written before about the amazing job the CDC is doing with their channel.

And the kicker is that web video is cheap. You probably have all kinds of video shot for other purposes that you could repurpose for the web. And you don’t even have to pay for a separate web site or video hosting. YouTube has it taken care of. It’s a mantra…video, video, video.


Jun 08

I took my friend to the ER and we were anxiously awaiting test results. Friendly nurses had drawn blood, run an IV and were very helpful. We had not yet seen a doctor yet. Finally, she strode in. “We have to admit you to the hospital. You have blah blah blah,” uttering some medical terminology we didn’t understand.

My friend, lying in bed, looked alarmed. But she didn’t ask about “blah blah blah” but said, “I don’t have medical insurance. How much will this cost?”

The doctor glared back and in a stern voice answered,

“You can turn and talk to that wall about prices. I don’t know. I’m here to save your life.”

Turn and talk to that wall?! I couldn’t believe it. Isn’t treating the patient treating the whole patient? Isn’t handling patient stress and emotional health part of recovery?

I know, I know…we were in the ER–handles acute stuff and punts over to others (thank God this Doc didn’t choose primary care as her specialty). But still, would it have been that hard to have said something else like, “I don’t know how much it’s going to cost, but I do know we see many people without health insurance. I will send someone to talk to you about your options.”

Talk to the wall? Come on, Doc, time to take a break and go find your compassion again.


Jun 05

Social news site, Digg, announced this week that they would allow readers to vote for ads that appear on the website, thereby driving the ads displays up, or burying them down. This provides real-time crowd-sourced data as to which ads appeal to Digg readers the most.

In a cosmic coincidence, I heard the Digg announcement the same day Dr. Thani Jambulingam suggested to me that pharmaceutical companies should rely less on traditional focus groups and use social media more to uncover unmet needs. “Dr. Thani” is the Chair of the  Department of Pharmaceutical Marketing at Saint Joseph’s University who also has considerable real-world experience in the life science industry. He specifically suggested that, like Digg, pharma companies should ask patients to create, critique and respond to potential ads. When I suggested they might already be doing that in focus group panels, he rightly pointed out that people respond more candidly when they are protected by remote, large group anonymity than they do when they are eyeball-to-eyeball with an interviewer.

A couple years ago Doritos used a home grown ad contest as part of their Superbowl campaign with great success. Digg is now looking for ongoing crowdsourced ranking. Tomorrow perhaps a bold healthcare marketer will use social media to launch a truly community connected campaign.


Jun 04

Novartis deserves credit for jumping into the social media space with a very unique site, CML Earth. Its purpose and audience:

CML Earth is a global interactive social network dedicated to connecting the CML community from around the world. We invite patients, patient groups, and healthcare professionals to join us in building this new online community.

This is an instance of a condition-focused social network which enables patients and their care givers to provide support and information.

The Designcml_earth1

In keeping with the name, the main interface to the site is a beautiful image of the Earth itself and member location is prominent. Like other web mapping program, you can zoom in and out and scroll to different locations. Small circles show where other members live. Most impressive, the site provides support for nine languages.

Like other social networks users can sign-up and enter their name, birth date, and location. But when it comes to telling “more about me” you are forced to select from a series of drop-down menus. Instead of just writing who I love, I have to pick from a list that includes my parents, my kids, etc.


This forced entry system is even stranger as it applies to telling your story. When answering “What I look forward to” you must choose from a pre-set list that includes items like “just being” or “laughing last.”

This forced set of choices for your personal information is so awkward there must be a good explanation for it. I would have guessed that it was so nobody had to screen the entries in the open ended fields, but in fact there is a final open text box that lets you write whatever you want. I just don’t get it.

The main purpose of social networks, or course, is to connect with others. You can see in the image below that you can get profile information on other members and, similar to Facebook “flair”, you can send members signs of encouragement by sending smiles, hugs and high-fives.cml2

When it comes to communicating with another member for some reason it doesn’t seem like too many users have activated that feature. You can go through a lot of members before finding someone who is willing to accept an email from you.

Guidelines and the Adverse Events Problem

When it comes to social media, health marketers often worry about things like spam, adverse event reporting, and negative comments regarding their brand. Novartis handles this with strict and clearly stated policy.

Refrain from sharing any treatment information or names of specific medicines or companies; Do not include any profanity or indecent or inappropriate language, whether in text or image; Do not embed any links in your profile.

So how does Novartis handle the dreaded adverse events reporting problem? Easily-they don’t allow them.  They inform users:

CML Earth is not the place to report adverse events.  If you wish to report a suspected adverse reaction to a Novartis product, click here.

The Business

Many companies are trying to make online patient communities a business, but in that regard most are struggling or failing (eg, Trusera). I suggest that online communities are a valuable tool, but just hard to monetize. To be sustainable online patient communities will have to

1)      be directly sponsored, like Novartis CML Earth

2)      be indirectly sponsored, like JDRF’s Juvenation which is sponsored by Novo Nordisk

3)      be hosted on a public platform, like McNeil’s ADHD Moms on Facebook

4)      be an add-on to an existing health information business

I don’t know what Novartis’ goals are for the site but I’ll bet they’ll exceed them. They have clear corporate branding-no hiding in the footer here-and rather than going for mass adoption they seem to be using this site as a tool to offer the community. It’s certainly going to be something to talk about when they are with physicians, and will earn good will among CML patients.

Areas for Improvement

Some things definitely jumped out at me during the review:

1)      Optimize for search engines-there is almost a complete lack of SEO effort thus far on the site. Keywords are limited to “cml” and “cmlearth”. This is such an obvious oversight that I would think they are purposely trying to fly under the radar, yet they are buying Google adwords to drive traffic.

2)      Tell the world-Novartis should issue a press release and upload their demo video to YouTube. Two simple actions that would drive awareness and a positive image for the company.

3)      Ditch the canned responses in profile-enough said.

4)      Add low-bandwidth or mobile version-the site is beautiful and uses a novel, geographical driven primary interface. But I wonder how accessible this site is in low-bandwidth countries in other parts of the world, and as many people do their social surfing from the mobile phones, a lightweight mobile version or iphone app is in order too.

5)      Provide content-one key that most private networks are ignoring is to provide a library of content. Even though the point is to connect members, a simple library of content-rich articles provides added value, makes the site stickier, and Google loves it too!


Novartis deserves high marks for jumping into the social network world with a very innovative, slick design. They deftly handle the AE issue with a clear policy. Hopefully they will open up the member profile data, make it mobile friends and do more to promote CML Earth to the rest of the world.