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Dec 23

wikipedia_logoType any drug name into Google and the odds are good that a link to Wikipedia will be among the top results. According to Alexa Wikipedia has consistently been in the top-20 most visited sites on the Internet since 2006. And with 75% of American internet users turning to the web for health information, millions of e-patients will inevitably end up on a Wikipedia drug page.

But how accessible is the Wikipedia drug content for patients, given that most American adults read somewhere between a 4th and 8th grade level (National Center for Educational Statistics, 2003)? Devin Pelcher, a Pharm.D. candidate at Nova Southeastern University, addressed this in a recent talk at Medicine 2.0, entitled “Readability of the Top 50 Prescribed Drugs in Wikipedia.”

Bachelors Degree Required?
Pelcher analyzed the Wikipedia pages for the 50 most frequently prescribed drugs in the U.S., judging the relative reading difficulty of each and measuring these results against the average American comprehension level.


While the Department of Health and Human Services, using the Flesch-Kincaid Grade Level (FKGL) assessment standards, classifies anything at a reading level above grade 9 as “difficult,” Pelcher found the mean grade level of the 50 sampled drugs was 15.5–well above a high school education.

Health Information Readability Also Poor

Pelcher also used an additional readability test in order to measure certain criteria the FKGL neglects to address. This system, called the Health Information Readability Analyzer (HIReA) looks at what makes a passage easy or difficult to read. It scores  text on semantic, lexical, syntactic, cohesive, and stylistic scales running from 1.0 (very easy to read) to -1.0 (very difficult). Again, most of the most commonly prescribed drug’s Wikipedia pages were found to be well outside the reading level of most Americans.


Are Patients the Intended Audience?
While its clear that for the average reader the Wikipedia article on a given drug may be largely inscrutable in terms of basic information, its difficult to determine what the broader implications are. Wikipedia articles are “crowd-sourced” from many different people and not from any one “official” sources. And while millions of patients may end up on Wikipedia pages, the goal of the drug articles is not patient education.

Simpler Is Not Always Better
Furthermore, a close look at specific cases reveals that simpler may not be better. The page for lansoprozole, a proton-pump inhibitor found to be one of the most difficult to read, provides detailed information about interactions with other drugs, side effects, and a comprehensive list of brand names the drug is sold under. The “easiest” article, for the blood pressure medication dyazide, is a mere two lines long and omits much information crucial to an e-patient looking for an informed opinion.

Will e-Patients Write The Fix?
Pelcher’s research is a fascinating look at how language can be a barrier even in a world of democratized information, but in focusing on the inaccessibility of “difficult” pages, it may neglect that these very pages might prove to be the most comprehensive.

Wikipedia’s greatest strength is that articles are living documents, shaping themselves to meet the needs of the community. With Pelcher’s findings in hand, perhaps readability and vital details can co-exist. But it will take a knowledgeable writer to craft the solution. Perhaps a “What Every Patient Needs to Know” section or “Links for Patient Education” addition should become standard elements on Wikipedia drug pages.

If you decide to add that Wikipedia content for a drug you are familiar with, let us know.


Editor’s Note:
The original post of this article mistakenly referred to Pelcher as holding the title of Professor and mistakenly credited Pelcher with the creation of the HIReA. We regret the errors.

Dec 21

interval_coverThe topic of social media return-on-investment (ROI) continues to be popular as innovators look to justify their efforts and laggards look for excuses. Compared to more tried-and-true marketing campaigns, the return on investment involved with social media can be hard to quantify.

Think Interval has contributed to the conversation with their white-paper, “Yes We Can: Measuring Marketing Performance for Hospitals and Health Systems.” It reassures health-care companies that while setting up consistent and useful measurement standards can be a difficult and time-intensive project, establishing a system of gauging marketing results in a Social Media (SM) environment is not only possible but crucial. They recommend a three-tiered system of “Marketing Performance Measurements.”

Financial Metrics provide the traditional ROI. How much money has your campaign brought in versus how much it cost? Financial metrics, if you have them, are the easiest to draw conclusions from, but getting them can be difficult, often requiring customer and patient actions to be tracked over long periods of time.


Action Metrics lack the bottom-line punch of financial metrics, but still deliverable measurable, concrete results. For example, a hospital offering a free booklet on the risks of arthritis can measure the number of requests for the information. Often these actions can be roughly equated with a financial outcome. Any campaign that can’t efficiently provide a financial metric should take care to track as many actionable angles as possible.

Attitudinal Metrics simply measure the attitudes and opinions of a selected audience. These could be the results of surveys, polls, focus groups, interviews, or even anecdotes. While these can be a useful gauge of what people are saying about you, it is important to keep in mind that attitudes often do not correlate with behavior. As a result, attitudinal metrics are usually the least useful of the three.

With definitions of what you can measure in hand, the paper goes on to discuss how to measure the success (or lack thereof) of a campaign. The first step, the micro-level, is concerned with figuring out how to measure the results of specific marketing activities. To quote the paper, “your goal is to answer the question ‘Did this campaign work?’ with a definitive ‘Yes, and here’s the evidence to back it up.’” The report offers a fairly detailed run-down of what you should be measuring as results vs. actions, and how exactly you should look at these results. First, define what actions you will be taking. An action can be anything, the paper says, from a simple one-sheet brochure to an expensive television spot. If your metric is your end-goal, then try to include as many activities in this metric as possible. Open-houses, phone reminders, promotional websites-it all counts.

Make sure to set an objective (for example, “200 new appointments this month”) and take note of your current baseline (”75 new appointments last month”) to compare the results of your campaign to (”225 new appointments”). Make sure to look into the relative results of previous attempts to boost the same or similar branches of your organization, and make sure the source of your metrics and whose responsibility each aspect of the campaign falls to are also noted.

We’ve written in the past that at Kru we think social media ROI needs to be based on the purpose of your social media efforts. For example, using social media to “listen” is akin to conducting a focus group, and proving ROI isn’t necessary or practical. But if your goal is to get them to buy your product, or visit your website, then hard ROI metrics are possible and should be pursued.

Dec 17

MobiHealthNews editor Brian Dolan summarizes with:

FDA may regulate smartphone apps. LifeComm closes. Best Buy stocks connected health devices. Apple invites LifeScan on-stage. The West Wireless Health Institute is founded. CardioNet’s reimbursement rate cut. Consumers want wireless health. Three-quarters of Americans are interested.

Click here to download their Wireless Health: Year End Report 2009 (PDF).

Dec 08

eBizMBA has ranked the top 20 health information websites using Quantcast and Compete data. The Top 20 are:

5 Yahoo! Health

It’s interesting to note that, at #20, gets 935,000 monthly visitors according to Compete. Basically, takes over a million visitors a month to  make the list and that still doesn’t guarantee you’ll make money using a web ad model.

Dec 06

Kru Research used the ListenLogic social media monitoring platform to monitor social media comments and measure sentiment for two cholesterol lowering drugs, Lipitor and Crestor, for one month (August 2009). An influence ranking of 5+ was used to reduce the amount of spam and irrelevant posts.

The questions we sought to answer were:

1)      What is the total number of comments for each of these brands?

2)      Which sites generate the most chatter (eg, Twitter, Blogs)?

3)      What is the overall sentiment score for each brand?

4)      Is there a difference in the topics or issues that are being commented on for each brand?

Share of Voice: Lipitor beats Crestor 2.3 to 1

After tracking 180 million websites and cleaning out the promotional chatter, we see that market class leader Lipitor had 695 total mentions and Crestor had 302 mentions. Lipitor has been on the market longer than Crestor, and is considered the best selling drug in the world, so it isn’t surprising that it has more activity on the social networks.

Little Difference in Sentiment-Mostly Neutral

When you look at all the conversations and comments about Lipitor and Crestor the vast majority, about 94%, is labeled “Neutral.” This is because most mentions picked up by listening platforms has to do with general corporate news, lawsuits, and investor related articles that mention the blockbuster drugs as part of their description of Pfizer and AstraZeneca. When you look only at health related comments, the picture changes.

Lipitor’s positive sentiment was approximately 9% versus Crestor’s 1%. Negative sentiment was 27% for Lipitor and 18% for Crestor.

Another way to look at sentiment is the ratio of positive to negative comments. Using this approach Lipitor scores .33 to .05 positive to negative sentiment.

Comment Cloud Analysis

The cloud tags shown below reflect that the brand names are being used in a variety of discussions that go far beyond the management of cholesterol.


Websites with Most Activity

Using a 5+ influence rating corrects for a lot of irrelevant chatter that happens on Twitter. However, both products unfortunately have most of their social comments happening on pharma gossip site CafePharma. Major sites that these chole

Of the 695 comments for Lipitor:

  • 46 (7%) came from
  • 36 (5%) came from
  • 22 (3%) came from
  • 18 (3%) came from
  • 13 (2%) came from
  • 11 (2%) came from
  • 10 (1%) came from
  • 9 (1%) came from
  • other

Of the 302 comments related to Crestor:

  • 17 (6%) came from
  • 12 (4%) came from
  • 11 (4%) came from
  • 10 (3%) came from
  • 7 (2%) came from
  • 6 (2%) came from
  • 5 (2%) came from
  • 5 (2%) came from
  • 4 (1%) came from
Dec 06


“Healthcare has traditionally not been a consumer oriented industry,” Bill Fox explains. “The doctor knew everything and the patient, the consumer, listened. Other industries don’t have this luxury and long ago figured out that he who hears the customer thrives.”

Fox is the Executive Director of the National Center for Patient Interactive Research (CPIR), a group dedicated to bringing power to the patient through innovative health information technology (HIT). He recently testified before the Federal Coordinating Council on Comparative Effectiveness Research as part of a panel discussing how to spend the $1.1 billion dollars targeted for such research. What CPIR brought to the table was an important realization-that the patient’s voice plays a crucial role in the future CER. The path to this lies in using technology to help create a stronger bond between the patient and the physician, what Fox calls a “therapeutic partnership.” As he puts it, the patient’s “is the only voice which is not being heard on a systematic, standardized, and measurable basis,” in the industry that needs that voice the most.

“It is well established that certain populations: minorities, the old, people with disabilities, do not get the same quality of care and have worse outcomes then other populations.  By giving every patient the ability to report on what happened in their encounter with the healthcare system we assure that every voice is heard. Getting the facts on the table is the first step to a transparent, fair healthcare system for all.”

He points out that patient engagement leads, in the long run, to better health as well, tending to choose less costly but equally effective procedures, and requiring fewer surgeries and acute episodes.

Fox believes the days of the physician as the sole decision-making voice in the clinic is over; as access to health information and empowerment online increases, patients can and should play a stronger role in their treatment. What other industry, he asks, plays as intimate a role in the consumer’s well-being, and what other industry, paradoxically, traditionally functions so independently of consumer input?

CPIR’s testimony pins down two points where patient interactivity can be enhanced and energized. The first is in the physician’s office itself, where new strategies on listening and communicating can help the patient set personal self-care goals. Fox points out several cultural shifts that will need to occur to make this possible. Physicians will have to learn how to ask more, and tell less. Patients will have to learn how to ask about and describe symptoms better, and how to set their own goals.

The second is a proposed follow-up system, where patients can use simple and intuitive technologies to “review” his or her experience. Did the physician communicate clearly and sympathetically? Provide the best possible service? Did the patient leave the office feeling good about his or her role in self-care? CPIR proposes that this data be collected and analyzed by an independent third-party and used by health systems, insurance companies, and researchers to look more closely at patient-physician relationships, as well as back to the patients themselves. “By measuring the patients voice at the point of care we set in motion the ability to measure quality more transparently, more fairly and more accurately - and for that measurement to get paid for throughout the healthcare continuum.”

Of course, this is an incredibly broad goal that depends on enthusiastic commitment and participation from both patient and doctor, above and beyond any outside initiative. Fox states that “this is a huge cultural shift, and as I said to the Coordinating Council, culture often eats strategy for lunch. We need to design fairness and transparency into these tools, for both clinicians and patients, and make sure we don’t fatigue doctors any more than they already are.  HIT should streamline and focus clinical practice.” Yet Fox stresses that the technology needed for patient input already exists in many forms, and all that remains to be done is implementation.

Above all, Fox’s model for patient empowerment hinges on “dignified accountability.” Asking informed questions, listening and self-monitoring, and taking responsibility for one’s health on a day-to-day basis all contribute to a clinical atmosphere that’s more like a meeting between peers than a lecture. “You energize patients by actually giving them responsibility,” explains Fox. “This needs to be done thoughtfully, but it needs to be done. The patient’s job is to take care of themselves - to work with their caregivers to be as healthy as possible given their conditions.  Just like any other job, they need the tools and the knowledge to do this.”

Dec 06

food-log3You’ve overslept by fifteen minutes, and you have a killer headache. A couple of Aspirins take care of that. Grapefruit and yogurt for breakfast, a 20 minute jog, and then off to work. You’ve just gotten a promotion and a new office with a gorgeous view, so you’re feeling pretty good about your career. At the end of the day you catch an hour of T.V., hop on the bathroom scale, and hit the hay.

This is the raw data of your life, the cold hard facts of diet, exercise, and attitude that determine your wellbeing, and TheCarrot is dedicated to measuring it. TheCarrot is an online and mobile collection of trackers that collect and calculate data pertaining to a wide range of health concerns. If you’re looking to lose a little weight, plug in what you eat at each meal or log your workout routine. Feeling stressed? You can log and rate your general mood, your quality of sleep, even your job satisfaction. For users with more specialized concerns, there are specific trackers for diabetes, menopause, hypertension, and a sort of WebMD-lite which tracks various individual symptoms.

What distinguishes TheCarrot from similar sites is the focus on mobility and, perhaps more importantly, on a full integration of all the above-mentioned aspects into a gestalt look at wellbeing. The platform’s Iphone app allows users to log in their meals and activities as they happen, even inviting users to upload snapshots of their food into a database. While a seemingly small point to tout, entering the contents of a meal is much easier and salient on the subway ride home than it is hours later, racking your brains for if you had the risotto or the orzo.

The platform’s integration of every tracker into your daily report is similarly based on small, intuitive touches. How many times have you patted yourself on the back for jogging two miles, and rewarded yourself with an ice-cream sundae, or offset a diet with an afternoon sitting around on the couch? TheCarrot, by collecting up all of your lifestyle trackers into one collated chart, stresses the importance of all-around health and wellness.


As Douglas Trauner, CEO of TheCarrot’s parent company, Healthcare Analytic Services, puts it, “until now there wasn’t a mobile, one-stop option for all areas of [health] interest.” This all-in-one, integrated method is what really sets TheCarrot apart.

picture-38However, this emphasis on breadth of content may come at the expense of depth in any one area. While the nutrition tracker is admirably well fleshed-out, with a nice range of customization regarding what information shows up on your reports (ranging from a simple calorie count to detailed data on sodium, protein, and more) and a stocked pantry of over 20,000 pre-selectable food entries, other trackers are less comprehensive. It’s great to be able to hold your exercise regimen up side-by-side to your daily diet, but without even giving a broad estimate of the amount of calories burnt by each activity at various durations, the actual functionality is sadly limited.

Other areas of the platform are similarly bare-bones, sometimes in surprisingly fundamental ways. Some, such as Energy Level, Sex, and Job Satisfaction, are merely sliding scales ranging from Low Satisfaction/Energy/Libido to high-a totally subjective criteria that fails to offer much meaningful data. Sleep is structured similarly, with an entirely separate tracker set up for wake-up time. The result is a jumble of trackers ranging from comprehensive and useful, to somewhat confusing, to the useless and/or redundant.

The site and its Iphone companion have undergone a general upgrade since August of 2009, adding numerous features and trackers to its original configuration. While the platform as it is today is far from perfect, TheCarrot’s ambitious scope and convenient, mobile-friendly approach make it a fascinating experiment and a worthy (if flawed) eFitness contender.

Dec 03

Previously I applauded the efforts of Novartis to embrace social media with the launch of CML Earth, their online community for people with chronic myeloid leukemia. When I reviewed the site I signed up as a member, and yesterday I received this email that shows they just don’t get it (yellow number citations are mine).


Novartis, it’s about personality, authenticity, being a real person who can be trusted! So what’s my problem with this email? Let me count the ways…

1) Subject Line — It’s not terrible, and they get points for being direct. But it’s very “me” centered, generic, and doesn’t provide a compelling reason to open the email.

2) From e-Mail Address — You’ve got to be kidding me. The mail actually comes from “DoNotReply”? I can’t imagine a less personal or caring address. In fact, in this day and age it’s downright offensive.

3) Salutation — This form email is inserting the member name into the greeting which is good. At first the “Dear” preface seemed a bit formal to me, but the average age of someone with CML is mid-60’s so probably appropriate to be a bit more formal in this email.

4) Body Copy — This is admittedly nitpicky but the paragraph block is too long and uses some passive voice which should be minimized.

5) Call to Action — Still impersonal but it’s good they actually have a call to action and remind the reader of the total number of members in the community.

6) Signature — Formal and impersonal. Yuck.

7) Footer — “Please do not reply.” Doesn’t that give you a warm and fuzzy feeling?

“Hey, it’s easy to take pot shots from the cheap seats,” you might say. Well, let me show you how this email should have been crafted.

First, there should be one or more patient leaders who actively lead the community. The monthly emails should come from them, not from a Novartis employee or a “DoNotReply” automated message. I’ll use my own name as the community leader for the example below. A rewrite might look like:


Subject: You can now add Caregivers to CML Earth

Hi <FirstName>,

I’m sure you know that CML Earth lets those of us with chronic myeloid leukemia connect with one another online. There are over 2,000 members in the community and I personally have made friends with people from all around the world. But of course we also know that CML affects our family, friends and other “Caregivers.”

The good news is that CML Earth is now open to Caregivers as well. Their stories, experiences and participation with our group will certainly inspire, educate and support all of us.

Please invite your loved ones to join CML Earth by forwarding this email or sending them this link:

And please log back in to CML Earth yourself to connect and encourage our new members.

Let me know if you have any questions or suggestions for how we can make our CML Earth community even stronger.


Kevin Kruse

See the difference? Feel the difference?

What is a shame is that Novartis is a great company and Gleevac is a real miracle drug. I know the Gleevac team truly cares about the CML community. Unfortunately, the team managing CML Earth seems to be ignorant of social media, community culture, and maybe even copy-writing which led to an amateurish and probably ineffective email.

What do you think?

Dec 02

The analysts at Gartner gazed into their crystal ball and list the Top 10 Consumer Mobile Apps for 2012. Coming in at number 5 is “Mobile Health Monitoring.” I think their use of “monitoring” as a qualifier is a bit narrow:

Mobile health monitoring is the use of IT and mobile telecommunications to monitor patients remotely, and could help governments, care delivery organizations (CDOs) and healthcare payers reduce costs related to chronic diseases and improve the quality of life of their patients.

Yes, health monitoring will be huge. But what about health search? Health education? Personal data trackers that don’t ping your physician or family unless you want them to? Apps for health and fitness? All of these mobile health apps will certainly be as big or bigger than the “monitoring” category itself.

Nike Plus is frequently mentioned as a model for the new hybrid of personal tracking device, data, and community. What other mobile health apps do you think show us a glimpse of the future?