Because nearly one billion users produce a lot of data, Facebook has had a hand in publishing more than 30 research papers since 2009, including research (.pdf) that may link social-networking activity and loneliness.
But outside researchers have been unable to validate those studies because Facebook refused to release the underlying raw data, citing the need to protect users’ privacy. Now Facebook is considering changes to its policy. Nature Newsreports:
Facebook is now exploring a plan that could allow external researchers to check its work in future by inspecting the data sets and methods used to produce a particular study. A paper currently submitted to a journal could prove to be a test case, after the journal said that allowing third-party academics the opportunity to verify the findings was a condition of publication.
There were two interesting developments in the field of social networks for healthcare practitioners last week. The first was the publication of a paper in JAMA “Variation in Patient-Sharing Networks of Physicians Across the United States”. The second was the sale of Sermo Physician Network to WorldOne for an undisclosed price. Sermo had raised $40+m in venture capital prior to sale, making a bet that social networking for physicians could drive value to pharmaceutical and financial firms based on disclosing interactions between members of the network.
If physician behavior and prescribing activity are key to your healthcare business, I think it is important to understand the relationship and differences between these two events.
Sermo bet hard on the Facebook model – physicians would interact on social networks, share knowledge and insight, and third parties could benefit from getting access to those interactions concerning their products or services. Sermo had also begun expanding its revenue model by providing paid content and sponsored education programs to network members, trying to capture “digital” dollars from life science companies. Pharma companies are desperately trying to gain advantage through digital advertising campaigns to influence physician prescribing behaviors, and multi-channel marketing efforts including the development of web sites for branded medications.
When the University of Pennsylvania Health System sought new patients for its lung transplant service last year, it turned to Facebook and Google.
The results of the $20,000 advertising campaign on the websites exceeded administrators’ expectations.
During a few weeks in August and September, more than 4,600 people clicked on the ads and 36 people made appointments for consultations. One of those is now on the hospital’s lung transplant waiting list, and several others are being evaluated, hospital officials say. While the response may seem small, each transplant brings in about $100,000 in revenue.
“We wanted to test the theory of how successful a digital marketing campaign could be,” said Suzanne Sawyer, the health system’s chief marketing officer. “It was like looking for a needle in a haystack,” she said, noting only about 60 lung transplants are done each year in Philadelphia, where the health system is based.
Among the most frustrating dilemmas facing patients – and physicians – is when doctors are unable to assign a specific diagnosis. Just having a name for a condition can be remarkably reassuring to patients (and families), providing at least a basic framework, a set of expectations, and perhaps most importantly, an explanation for what the patient is experiencing.
Sara Wheeler, writing in the New York Times in 1999, poignantly described the experience of traveling through “the land of no diagnosis.” Ten years later, the NYT featured a story called “What’s Wrong with Summer Stiers,” about another patient without a diagnosis – and about a fascinating initiative at the NIH, the “Undiagnosed Disease Program” – specifically created to meet this need.
Investors just ponied up well over $100 billion for a piece of the social media giant Facebook. While Mr. Zuckerberg and his co-founders deserve a hearty congratulations, I find some eerie parallels between Facebook and accountable care organizations. The similarity does not bode well for either business model.
1. The users are not the customers: Facebook sells its users to marketeers. ACOs sells its patients’ health care utilization to insurers.
2. It’s the data and it’s not yours: Facebook’s targeted ads are constructed off of prior usage patterns. ACO’s shared savings calculations are built off off actuarially determined health care utilization patterns.
3. Sovereign hostility: Washington DC views information technology and health care as distractions from the true task at hand: restoring the U.S. manufacturing base.
4. Do you care, really? Now that the wunderkids in charge of Facebook have made their millions, it remains to be seen if they’ll work as hard in delivering value to its users. Ditto for all the salaried docs working for ACOs, who no longer have to arrive early, skip lunch and stay late.
5. The long term: Yahoo once was the darling of internet investors. Even if ACOs have initial success, is a better care model being developed as you are reading this?
Just as the little mobile wireless devices radically transformed our day-to-day lives, so will such devices have a seismic impact on the future of health care. It’s already taking off at a pace that parallels the explosion of another unanticipated digital force — social networks.
Take your electrocardiogram on your smartphone and send it to your doctor. Or to pre-empt the need for a consult, opt for the computer-read version with a rapid text response. Having trouble with your vision? Get the $2 add-on to your smartphone and get your eyes refracted with a text to get your new eyeglasses or contact lenses made. Have a suspicious skin lesion that might be cancer? Just take a picture with your smartphone and you can get a quick text back in minutes with a determination of whether you need to get a biopsy or not. Does your child have an ear infection? Just get the scope attachment to your smartphone and get a 10x magnified high-resolution view of your child’s eardrums and send them for automatic detection of whether antibiotics will be needed. Worried about glaucoma? You can get the contact lens with an embedded chip that continuously measures eye pressure and transmits the data to your phone. These are just a few examples of the innovative smartphone software and hardware — apps and “adds” technology — that have been developed and will soon be available for broad use.
As an ever increasing amount of money seems determined to chase an ever greater number of questionable ideas, it’s perhaps not surprising that inquiring minds want to know: (1) Are we really in a tech bubble? (2) If so, when will it pop? (3) What should I do in the meantime?
I’m not sure about Question 1: I’ve heard some distinguished valley wags insist we’re not in a tech bubble, and that current valuations are justified, but I also know many technology journalists feel certain the end is neigh, and view the bubble as an established fact of life – see here and here. The surge of newly-minted MBAs streaming to start-ups has been called out as a likely warning sign of the upcoming apocalypse as well.
I have the humility to avoid Question 2: as Gregory Zuckerman reviews in The Greatest Trade Ever, even if you’re convinced you’re in a bubble, and you’re right, the real challenge is figuring out when to get out. Isaac Newton discovered this the hard way in the South Sea Bubble, leading him to declare, “I can calculate the motions of heavenly bodies but not the madness of people.”
I do have a thought about Question 3, however – what to do: reconsider digital health — serious digital health.
Here’s why: Instagram and similar apps are delightful, but hardly essential; most imitators and start-ups inspired by their success are neither. It doesn’t strain credulity to imagine investors in these sorts of companies waking up one day and experiencing their own Seinfeld moment, as it occurs to them they’ve created a portfolio built around nothing.
Sir Muir Gray, of evidence-based medicine fame, is a man who speaks his mind – often in 140 characters or fewer. “Show me a paper by a management academic,” he Tweeted, “that has changed the way we deliver health services” [and, implicitly, improved patient outcomes].
Part of me agreed with him, but I’m married to a management academic (“Oops sorry, better man than me,” Muir backpedalled), who helped me rise to Muir’s challenge.
We kicked off with a paper almost every clinician has heard of:
Kaplan and Norton’s ‘balanced scorecard’, published in Harvard Business Review in 1992 and cited over 8000 times since . The scorecard was aimed at company directors who wanted some quick (and, one is tempted to suggest, dirty) metrics to monitor what their customers thought of them and where they should direct their efforts for the future. It has certainly changed practice (many healthcare organisations use it), but we were not overly sold on its transferability to the healthcare setting.
When most of us think about Facebook, the first phrase that comes to mind probably isn’t “good Samaritan.” Facebook is an easy way to keep in touch with friends, and it can be a gigantic time-suck, for sure, but last week the site did something that could truly benefit a lot of people. On May 1, Facebook launched an initiative to encourage users to become organ donors, and within 24 hours there had been a spike in the number of people volunteering their body parts for the good of others.
California’s registry saw almost two months’ worth of people sign up within the first day after the Facebook put up the feature.
Organ transplantation is one of the miracles of modern medicine, but there simply aren’t enough organs to go around for all the patients who need them. According to the United Network for Organ Sharing (UNOS), there are 72,900 people on active lists waiting for an organ. Compare that number to the 2,263 transplants that took place between January 2011 – 2012. Last year, more than 6,000 people died waiting for an organ.Obviously, increasing the number of organ donors could have a huge impact on the number of transplants – and on the lives of thousands of people.
Why don’t more people become donors? Some object on religious grounds, but the biggest obstacle is inertia. Most of us who sign up to be organ donors (I’m one of them) do so when we renew our driver’s license, by checking a box on a form saying we want to donate our organs. If you don’t mark the form, it’s assumed you don’t want to donate. Most people only encounter this choice every few years, when their driver’s license is up for renewal, and it’s hard to think about such a decision while standing at a Department of Motor Vehicles counter.
Some countries, such as Spain, Australia and Germany, have opt-out systems. It’s assumed that you are willing to donate unless you’ve said you prefer not to. Rates of donation in those countries are sometimes higher than in the US, although some presumed-consent countries have much lower rates. (Factors other than the number of donors, like the availability of surgical facilities and transplant surgeons, can affect the number of actual transplants in different countries.)