Digital Pharma West in San Francisco

I’m heading out to San Francisco where I’m co-producing Digital Pharma West where I’ll be on a panel to discuss, among other things, Pharma’s integration of emerging technologies. I’m excited because I get to meet a lot of brilliant people interested in taking the lead in forging new paths for the industry.

There’s still time to register for the event and get a chance to network with a lot of talented people. Here’s the attendee list:

I’ll write more about the event as it approaches and blog while there as much as possible. You can follow the hashtag for the even on Twitter: #DigiPharm.

I hope to see you in San Francisco!

Pharma’s Social Media Onion

I’m a big believer in connections. The Web is opening up novel ways of connecting machines with machines and people with people. Networks that used to take months or years to create can now be established in days or even hours. For Life Sciences industries, this means biologists, engineers, doctors, consumers, government agencies and marketers can connect and interact within minutes – and they can do this via multiple media, from text to video.

Of course the flip side of instant connection include numerous dangers: security breeches, privacy violations, spam, flawed information, process hurdles, cultural clashes, etc.


In order for an industry like Pharmaceuticals to be successful in online community engagement, it has to be able to peel away – like a giant onion – many many layers:

  1. Cultural sludge
  2. Resistant political domains
  3. Organizational fears
  4. Local and federal regulations (including interpretational ambiguity)
  5. Resource allocation
  6. Talent acquisition and training
  7. Process planning, design, implementation and evaluation
  8. Ethical awareness and discipline
  9. Content creation abilities
  10. Conversational skills – including a profound understanding of diverse cultures
  11. Documentation management (e.g. Adverse Events require consistent documentation procedures)
  12. Establishing a consistent and unifying online “voice”
  13. Cross-departmental and talent osmosis (e.g. Communications staff need to understand clinical processes, while clinical staff need to understand communications)
  14. Competing philosophies and ideologies and departmental directives
  15. Actual and public perception of engagement independence.
  16. A clear understanding of the difference between instant and real-time communications.
  17. Investor obligations (e.g. Investors demand rates of return in accordance with risk preferences – any process which adds another layer of risk with little perceived return is harder to advance)

Pretty daunting, yes? And this is the abridged list. Here’s what’s more: each layer that has to be examined and peeled away adds an additional order of complexity. The mathematics of this is not linear – that is, the aggregate order of complexity is not the simple sum of all the layers. I don’t know if it’s geometric or exponential, but it’s daunting.


It’s easy for advocates of social media and engaging with customers (be they consumers or doctors or the public at large). The reality, however, is that the order of complexity for Pharma to be safe and effective (so-to-speak) is high. That doesn’t mean at all that Pharma should sit in the sidelines.

But it does mean that Pharma will have to devote extensive care, attention, labor time, hard work, courage, creativity and supple musculature in order to be remarkable. Online, if you’re not remarkable, you’re nothing. There’s no return on mediocrity.

Anyone who has had to peel away an onion (either a real one, or a psychological one) knows the tears that can flow. It’s not as easy as it looks.

And yet…we all need to break-through difficult times. We all need to peel away layers of the onion.

The Web is making clear that organizations simply won’t be successful in community management and leadership unless they do the hard work of re-thinking and re-envisioning a simpler way of doing business.

What I’m saying is this: the “social media” challenge for Life Sciences isn’t social media. It’s all those layers of the onion.

Of course, once you’ve peeled away those layers, you find yourself confronted with a fresh view of the world. One you get through those layers, the world doesn’t seem so complicated. In fact, you start to see opportunities where you once saw danger.

Better to Play It Safe

When a new force in the world makes life more difficult and frightening and upturning – like the Web – the stakes get higher. So many things can go wrong if you don’t do it right. You can get stampeded and lose the game. Playing on the sidelines is more appealing.


The Web is making the world more and more dangerous. If you run a pharmaceutical enterprise and decide to blog or tweet or otherwise open yourself up, people will report adverse events. If that happens, you’ll have to work harder. That means more standard operating procedures, more trained personnel- maybe even more fines and letters from the FDA. Playing on the sidelines is more appealing.

If you run a hospital and decide to establish a vast living presence on the Web, people will say bad things about your doctors, your nurses, your waiting times in the ER, your food. You’ll have to deal with HIPAA. There’s also a chance that you’ll say something you’ll regret. Playing on the sidelines is more appealing.

If you run a newspaper and decide to use Twitter to gather information, distribute the results of your journalistic excellence and express opinions, people will stop buying your paper. Why should people buy your newspaper when they can get content for free? Getting to the point of dazzling the people with your professional curation skills is just too hard to do anymore. Turning the very technology that turned your industry upside down into your favor is risky and hard. Playing on the sidelines is more appealing.


Of course, you could look at the world through different lenses. You could look upon the Web as a sea of infinite nonsense, a place where people are thirsty for rare perspective and wisdom and value. The sidelines may be more appealing, but you won’t find any goal posts there. That’s not where the game is.

What does safety mean to you? Are you doing what you do because it feels safe? Are you sure that you’re truly playing it safe?

Wearing a life preserver in a jungle won’t help you.

If you do the hard work to make it easy for patients and doctors to report adverse events or file complaints about the treatment they received (or didn’t), you have a better chance that your product won’t get slapped with a black label or pulled from the market or that your hospital will get sued by people who feel abandoned or without recourse to you.


If hard work or changing your view intimidates you and you don’t mind living on the sidelines, it’s better to play it safe.

Sometimes, however, the world changes so fast, so cruelly, so unforgivingly that the safest bet is to live dangerously. Sometimes, it’s not better to play it safe.

Your choice. Win or lose. Eat or starve. It’s that simple.

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17 Best Posts in 2009- A Year of Social Media and Health Care

2009 was an important year for getting healthcare more up-to-date with web technologies. We have a long way to go: healthcare marketers have begun the process of sorting out the meanings of internet media. 2009 was also a year of extreme noise and echo-chambering. But that’s OK: that happens all the time with novel technologies, especially when there’s little understanding of them nor clarity about their purposes and uses and limits.

On this blog, I’ve always aimed to express my perspective on these technologies (which I believe is rather unique – and it’s this uniqueness which I hope provide you with something of value). Prior to 2009, it was a bit of a lonely place to discuss how health care could best adopt 21st Century technologies. But 2009 brought a first flood of attention. I believe Twitter may deserve credit: many hospital and other health care organizations never understood the Web much, and blogging must have seemed like a purely terrifying experience. But Twitter offered the uninitiated with a simple interface and connection.

As the year moved on, I decided to launch a Twitter chat for registered nurses – and the public in general. The hashtag is #RNchat and you can follow @RNchat on Twitter and subscribe to the blog which posts transcripts of the chats. Since most of the Twitter chats on Twitter are about how to talk about how to talk about talking about Twitter and other social media, I figured at least one of them should be about something that’s actually real. I’m kidding of course. No, I’m not. :)

At any rate, I’ve collected some of my best posts for the year. All of these posts are related to health care – although #3 only very indirectly (I had to include it because it serves as a release from all the social media hype I’ve been hearing for years). Scan the list and pick a few to read and share. Here are the 17 posts:

  1. 140 Health Care Uses for Twitter – I wrote this post because I wanted to start an open conversation about the opportunities we have with technologies and the cultural and regulatory limits stemming them. Years earlier, I had tired of paper medical records and bizarre bureaucratic rituals which slowed the pace and effectiveness of patient care. The idea of using micro-sharing communications as a way to “cut to the chase” in patient care had been working in my mind for some time. This post is the result.
  2. Pharma, Presence Marketing and You – Not having a marketing background – and yet fully understanding the importance of marketing in health care – I’m fascinated at the stumbling blocks beset before pharmaceutical and medical device companies: both from regulatory agencies and the companies’ own prejudices about what marketing means.
  3. Twitter & LSD – 25 Similarities – OK – is this a health care related post? Well, I consider humor a part of health care. And I do touch on the addictive qualities of Twitter in this post. I plan a series of posts in 2010 on Internet Addiction. So, go ahead – read this. And definitely tweet it out!
  4. The Social Capital Algorithm – A simple visual way to break down the utility of social media into simple concepts.
  5. Social Capital: An Accounting View of New Media – I started my career in accounting. As such, I don’t have much tolerance for vague references. And yet we use them all the time. This is just another way to look at the differences between financial capital and social capital.
  6. 1,001 Remarkable Pharma People to Follow on Twitter – A tease of a title. But I explain why you don’t need 1,001 people to follow to get value out of Twitter. Since this post was written, the FDA had a Public Hearing and you can follow the Twitter hashtag  #FDAsm for the latest.
  7. 66 Ominous Predictions About Twitter in Healthcare – This was my attempt at bringing some sanity (albeit humorously) into the social media echo-chamber. Those of us who are truly passionate about these technologies must challenge them. (Some of the Pharma predictions are interesting in light of the Public Hearing later on in the year.)
  8. Healthcare on Google Wave – Google Wave was one of those hyped Google products. I think it’s a powerful set of technologies, even though I don’t use it much myself (the API needs to be developed upon before it becomes truly usable). This is an embed of a Healthcare wave, demonstrating real-time embedding of content from Wave to blog.
  9. A Clinical Infusion of Google Wave -A hypothetical use case for Google Wave in the clinical setting.
  10. Healthcare’s Google-Facebook-Twitter Platform – Questioning the possibility of a gigantic healthcare social platform.
  11. Zen and the Art of the Tweet – Again, the theme of the health care effects of social technologies on our lives.
  12. An Interview with #hcsm Founder @danamlewis
  13. An Interview with @EndreJofoldi of HealthMash
  14. How to Make Health Care Remarkable – The @ePatientDave Interview
  15. Pharma & Social Media: Best Strategic Learning Investment for 2010 – Discussion of an eBook compiled by Ellen Hoenig about what things Pharma should focus on learning in 2010.
  16. Privacy Matters: Dirty Little Secrets Are Essential to Your Health – My attempt at resurrecting privacy from the social media rumors of its death.
  17. Can We Ever End Social Media Nonsense? – My concerns and hopes for the future of the so-called Social Web.

I’m anticipating 2010 to be a fast-paced year with many developments technologically, politically, economically and culturally. I’m hoping that the healthcare community not only continues to learn these technologies but also starts to think reasonably and productively about how to become better organizations.

Social Media won’t make a bad organization good, nor a good organization great. No, people do that. People with brains and creativity and chutzpah. People who have the courage to do what’s never been done before. Are you one of them? Or are you a cog in a machine that’s doomed to shut-down long before you retire? Either way, it’s never too late to change your part of the world.

I love you, my dear readers. Enjoy 2010!

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66 Ominous Predictions About Twitter in Healthcare

Is Twitter safe and effective?

Several years ago, as a second-career registered nurse practicing critical care – having a prior background in enterprise working with fairly sophisticated information technologies – it was all too easy for me get frustrated with paper medical records and laboratory reports laying in floors drenched in  Clostridium difficile.

How was it possible in the 21st Century that the informational flows in healthcare facilities could end up on contaminated floors? Surely, I thought, there must be technologies within our grasp that could spare us – our patients and the staff – such dangerous indignities.

I can’t remember where I was when I first heard of Twitter, but I was one of its early adopters. It occurred to me that Twitter’s essential feature – the power to share data instantly and briefly – was worthy of consideration in health care. But my early ideas about invoking Twitter into healthcare faced two hurdles: HIPAA always got in the way of my thinking and nobody else I knew at the time ever heard of “a Twitter”.

After Twitter deleted my first account, I gave up on the incompetent service. When I returned to Twitter sometime in early 2008, the use of Twitter (or any other social medium for that matter) in healthcare was still relatively unheard of.

Part of the reason I started blogging was to fill a relatively empty void in the healthcare social media space. Today, I believe we are seeing that space filling with more important voices. Since publishing 140 Healthcare Uses of Twitter in January, hundreds of hospitals have started up Twitter accounts. Every day we hear about Twitter’s role in health care, from disaster management to surgical live-tweeting.

So far, the word is largely positive concerning the experiences of a relatively small number of hospitals on Twitter. But has Twitter gone through the strainer, the one beyond the marketing and PR uses? I’m not so sure but I’m hopeful. Time and the further adoption of the service will tell us more about its safety and effectiveness.


A purpose of the list I published in January was to start a discussion about how micro-messaging technologies like Twitter could be used in health care. Twitter’s fame and hype continue to skyrocket and health care is one of the hottest topics of our time. I have no doubt now that micro-messaging and health care are important partners. My task then was to be an evangelist in a time of sparse awareness. The questions now are how far we will go with these technologies and what kinds of challenges and fears we are willing to face and overcome.

For as much as Twitter is now being examined by the healthcare and pharmaceutical industries (a welcomed step), we have yet to flesh out practical opportunities and dangers Twitter poses for them. I am encouraged that hospitals are tweeting. Some are doing remarkable work and learning as they proceed. But I also have concerns about the incorporation of Twitter in the healthcare setting. I know all too well about Twitter’s seductions. Twitter makes almost everything easy, including regret.

I have therefore assembled a collection of dark predictions about how Twitter may be misused or misappropriated. My task now is to be Devil’s advocate during a time of attention obesity.

I don’t know if I saved Follow Friday. I do hope that in the rush to embed Twitter into our daily lives that we strike the right chords between Twitter Evangelism and Devil’s Advocacy.


  1. That physician you’re following on Twitter will turn out to be an impostor.
  2. Your Direct Message will FAIL. Horribly.
  3. Your organization/practice will violate HIPAA. Repeatedly.
  4. Patients who don’t fully understand Twitter’s viral powers will find themselves woefully embarrassed.
  5. Your surgeon will tweet the wrong body part.
  6. Disaster management will be a disaster thanks to spam.
  7. Pandemic alerting will be a mess thanks to spam, panicked retweets, amateur microbiology and the Baumann Uncertainty Principle.
  8. Twitter will never reserve hashtags for sole use by the CDC or FDA or any other public service to guard against spam and keep channels of authority clear.
  9. Big Pharma will pay out tens of billions of dollars in fines and civil lawsuits related to alleged misleading statements in the course of tweet-marketing.
  10. Pharmaceutical company Twitter accounts will be hacked and the exploits will tweet misleading drug information, malicious links, confidential legal settlements and other embarrassing material.
  11. Twitter’s curious effects on  Dopamine will lead to addictive behaviors interfering with activities of daily living.
  12. Some disappointed healthcare marketers will revert to the traditional broadcast model of marketing after realizing quarterly earnings aren’t immediately boosted by providing free value to the communities they serve.
  13. Twitter will accelerate the proliferation of self-diagnoses.
  14. Insurance companies will find and track patients by viewing the follow lists of public-timeline hospital Twitter accounts.
  15. Insurance companies will set up dashboards to monitor insureds and use the information profitably.
  16. Twitter chats about healthcare reform will be infiltrated by Townhall-like Hashtagging.
  17. Patient dignity will be violated by nurses and doctors who tweet about their shifts from hell.
  18. Big Pharma and medical device companies will pay out tens of billions of dollars in fines (again) years after the FDA decides what regulatory rules to impose on tweeting.
  19. Lawyers will set up dashboards to monitor the tweets of pharmaceutical companies, device manufacturers, doctors and healthcare organizations in search of opportunities.
  20. Big Pharma will find itself finally engaging with patients on Twitter, only to realize that having 1,550,000 followers on Twitter means having to employ armies of drug safety associates 24/7/365.
  21. Twitter chats around specific disease processes will be polluted not only with spam but also misinformation masquerading as evidenced-based medicine.
  22. Patient-provider boundaries will be broken at alarming rates.
  23. A patient with depression will enter an unstoppable cycle: depressing tweets which lead to being un-followed and ignored, leading in turn to more depressing tweets…
  24. During a live-tweeted procedure that goes wrong, staff will forget to personally attend and inform the family reading the tweets.
  25. Privacy settings in Twitter will be reset to public, either by a Twitter glitch or hack or user-error and patient data will be inadvertently published.
  26. Psychotherapists using Twitter to communicate with patients will misinterpret or miss a patient’s tweet, resulting in a suicide.
  27. Hospital staff will tweet out information related to an incident.
  28. The overuse of Twitter will increase hypomania in patients with bipolar affective disorder.
  29. Obesity will continue to proliferate as healthcare consumers spend more time on Twitter looking for diet and exercise tips.
  30. Tweeters expressing suicidal ideation will be trolled by malicious malcontents.
  31. The wrong kind of medical crowdsourcing will lead to the wrong diagnostic judgements.
  32. Nurses who are not accustomed to the safe use of clinical micro-messaging will be distracted from their bedside duties.
  33. Doctors in facilities that employ enterprise micro-blogs may issue the right order to the wrong patient.
  34. The wrong laboratory results will be mis-tweeted. Fortunately, a smart nurse will notice the discrepancy between the lab value and the patient’s signs. This time.
  35. Patient timelines in facilities using micro-sharing technologies will be confused, causing all sorts of mayhem during shifts.
  36. The tweets of doctors will be used in courts to contradict testimony regarding timeline claims.
  37. The content of doctors’ tweets will be compiled and analyzed to challenge their competencies.
  38. Twitter chats about Obsessive-Compulsive Disorder will never end. Twitter chats about Obsessive-Compulsive Disorder will never end. Twitter chats about Obsessive-Compulsive Disorder will never end. Twitter chats about Obsessive-Compulsive Disorder will never end. Twitter chats about Obsessive-Compulsive Disorder will never end.
  39. Nurses will lose their jobs for posting TwitPics of patients in undignified positions.
  40. Family members will stick their unsolicited noses in each others’ health matters.
  41. CDC will inadvertently create panic during a major outbreak after a single malformed tweet is retweeted relentlessly. CNN and Fox News, confusing Twitter with sourcing, will re-broadcast the tweet, fueling more retweets and distortions of the original tweet.
  42. Small practices using Twitter for scheduling will tweet the wrong patient or time.
  43. Hospitals will monitor their staff’s Twitter streams for violations of confidentiality and other reasons for discipline or termination.
  44. Hospitals who don’t understand the subtle dynamics of Twitter-sociology will find themselves in front of public relations nightmares.
  45. Healthcare information consumers will be under-served by over-reliance on 140 characters, especially by organizations that don’t have a well-rounded social presence on the web.
  46. Hospital administrators will tweet annoying requests to staff busy with more important tasks.
  47. In a maternity ward, somewhere in the Midwest, the grandparents of twelve girls will read a tweet saying “It’s a boy!”, only to find out someone saw something that wasn’t there.
  48. A drug guide application accessible via Twitter’s API will tweet back the wrong dosage information.
  49. Shortly after retweeting the funniest thing she ever read, a newlywed will find out about her husband’s STD.
  50. Pharma will receive an unprecedented volume of Warning Letters for its uses of Twitter.
  51. A pharmaceutical company will inadvertently issue a drug safety alert about the wrong drug, resulting in billions of dollars in lost sales with a single tweet.
  52. A pharmaceutical company will not issue a drug safety alert, resulting in billions of dollars in lost sales with a single tweet.
  53. The FDA will issue a drug safety alert about the wrong drug, resulting in billions of dollars in lost sales with a single tweet.
  54. Practices using Twitter for patient care reminders will mix up patient Twitter accounts, causing confused home-care.
  55. A psychiatrist being sued for breech of confidentiality on Twitter will be relieved when she discovers that Twitter’s search engine no longer returns her troublesome tweet. Unfortunately for her, the lawyer suing her will find the tweet on FriendFeed’s search.
  56. Hospitals who should be blogging or otherwise investing in a larger social media landscape will over-invest in Twitter, since everybody has Dopamine receptors (see #11).
  57. Segments of the health care population who aren’t using Twitter will be overlooked or under-served.
  58. Allied care coordination, will be hampered by confusing tweets.
  59. Patients will increasingly realize that they can tweet adverse events on Twitter.  4Chan will catch on to this too. The big heart of a near-retirement CEO in Big Pharma will enter ventricular fibrillation. He will survive and will be prescribed the medication fictively referred to in #52.
  60. David will become internet famous during the next major infectious outbreak. The public, unaware of  @CDCemergency, will go to the most logical Twitter name for CDC:  @CDC. The confusion will lead to the conclusion that CDC is not on Twitter and will turn to bogus accounts and spammed hashtags for updates. This oversight by CDC and Twitter will go down as one of the biggest failures to capitalize on brand equity.
  61. The FDA will finally issue guidance allowing pharmaceutical companies to tweet links to products. Curiously, the FDA will encourage those tweets to be “non-retweetable”, stating that it will use its discretion in fining companies $10,000 for each retweet if, in the FDA’s opinion, the tweet appears “overtly re-tweetable”.
  62. The FDA will allow healthcare applications to be built on Twitter’s API. What’s more, the FDA, in its recognition of the importance of real-time technologies in our daily lives, will outline an efficient seven-year approval process for each application.
  63. Remarkable healthcare applications will be built on top of Twitter’s API, spurring wider acceptance of Twitter in serving the health care needs of the public. Unfortunately, Twitter will make unannounced changes in its API.  Jesse Stay, having helped to develop one of the most downloaded Diabetes iPhone apps, will suffer a brain aneurysm while discussing the changes with Twitter. He will survive and recover but will go on to delete his Twitter account and give up application development.
  64. The FDA, realizing Twitter’s role in public health, will require pharmaceutical companies and device manufacturers to publicly tweet Serious Adverse Events within 24 hours of receipt of notification. The hypothetical executive referred to in #59, in an extraordinary episode of psychosis, will go postal and use Twitter to live-tweet his rage. From that day onward, the phrase “going postal” will be replaced by “going Twitter”.
  65. HIPAA will be repealed and replaced with the Health Insurance Tweetability and Liability for Electronic Records Act of 2010. Among the provisions is the requirement that hospitals with public Twitter profiles not display their Following and Followers on their accounts. Twitter, of course, will offer no way to do this.
  66. Highlighting the power of Twitter’s monopolistic communications platform after a series of national health emergencies and a major terrorist attack coordinated in part via Twitter, the U.S. Congress will pass the Public Health And Safety Communications Act of 2012. Twitter Inc. is deemed a public utility holding company and enters an indefinite licensing agreement with the Department of Energy, whose charge is “to ensure the safe and uninterrupted use of Twitter and other micro-messaging services during times of national and international crises”. Twitter’s long-standing liquidity issues are finally resolved.


That last prediction may be the most dramatic, but given the tenuous state of our world’s psyche, it’s not far-fetched. Would it surprise you if it happened?

Am I being sarcastic or serious here? Does it matter? I mean: if we are to put safety and effectiveness above all else, shouldn’t we plumb the dangers posed by a real-time web?

Here’s another way to look at this list: as implied solutions to problems we may not have considered. Nothing is necessarily inevitable – awareness can prompt avoidance.

Twitter is telephony. Twitter is telepathy. Twitter is good. Twitter is bad. Twitter is useless. Twitter is useful. Twitter is whatever you make of it.

Twitter’s uses in Healthcare or Pharma or Politics or Marketing or any other field don’t so much depend on the technology as much as our willingness to be creatively courageous in the face of rapid change.

How we use Twitter in healthcare to streamline clinical operations, to provide richer experiences for consumers of healthcare information and to effectively propagate critical messages in times of crises depend on how willing we are to re-examine our traditions and re-envision what remarkable health care looks like given our new powers. We need leaders who aren’t afraid to break stupid rules and flush out deep prejudices.

In healthcare and other life sciences, following the rules is a vital part of the game. In fact, it usually is the game. Which is to say: leadership in healthcare is uniquely risky business.

For those of you who are currently using or planning to use real-time technologies in health care, think optimistically but responsibly about how you go about using them. Twitter and its yet-to-be-developed analogues bring forth into our world dangerous opportunities. When thinking about these dangers, here is a tweet-sized pearl of wisdom from Frederich Holderlin:

But where there is danger,

a rescuing element grows as well.

What do you think are the dangers of real-time social communities in healthcare? How would you propose we overcome those dangers? What are the rescuing elements among evolving – and sometimes unpredictable – threats from social technologies?

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