Hospitals Pushing the Envelope with Social Media

This article also appeared in odwyerpr.com.

The Line Between Marketing and Education Begins to Shift

The usually conservative hospital sector has started to embrace social media. Whether it's increasing competition, the need to keep patients coming through the door, reputation management or recruiting, hospitals are turning to these new web-based tools for assistance in increasing numbers. Ed Bennett, the director of Web Strategy at the University of Maryland Medical System, keeps tabs on this: there are 128 hospitals that have YouTube channels, 87 with Facebook pages, 140 have Twitter accounts and 23 have blogs. It's notable but still a minority. There are over 5,000 hospitals in the US.

In the StarTribune (Minneapolis-St. Paul), Chen May Yee spotlighted how "Mayo Turns to Social Media to Reach Out to Potential Patients." Lee Aase, manager of Syndication and Social Media, has helped to give the famous medical center an even greater public platform. Indeed, it was reported that he has developed so much expertise that he "travels the country to speak at conferences and runs his own virtual Social Media University, Global (SMUG), a web site with courses such as Blogging 101." The newspaper called him "a rock star in that space where social media and health care marketing overlap."

Two good examples of appropriate and valuable uses of the technology include Innovis Health in Fargo, which used Twitter to help people find the safest route to the hospital during the recent floods in North Dakota, and the University of California at San Francisco, which used YouTube to reach out to potential patients for a clinical trial that had difficulty enrolling volunteers.

But I see another side to this coin. In "Webcast Your Brain Surgery? Hospitals See Marketing Tool," Pam Belluck of The New York Times reported on a surgeon who was tweeting during the removal of a kidney tumor. He said, "Gosh, this is big" and "Could I have picked a harder case for this?" The hospital's web services manager said, "some bleeding needed to be controlled," but "we just tweeted right through it." Maybe there is some educational value in this but my first reaction was "please stop tweeting and give your full attention to the patient!"

Methodist University Hospital in Memphis transmits live webcasts for some surgeries. After seeing an advertisement for an upcoming craniotomy, a man called to volunteer and was accepted to be a patient. He said that if the doctor "was operating live on the web, he must be pretty darn good." What the hospital told the Times, however, was that a back-up video is always at the ready. "If something unforeseen happens and you need to cut away from the surgery, you can fall back on your previous surgery." OK, you want to spare your audience (and the family) from potential tragedy but there is something bait-and-switch-ish about this.

As we've seen, some of the most venerable names in patient care are joining other industry sectors in engaging the public. But does that make it right? Should hospitals behave like consumer goods companies?

The biggest questions, in my view though, revolve around ethics and value:

1. Is the particular use or application ethical? While hospitals take great care in protecting patient confidentiality, more care needs to be applied to marketing and public relations. Sure, sharing information is great. But Jeffrey Kahn, a University of Minnesota bioethicist, pointed out in the Times article that, while there is "value in demystifying medical care," the ability to use new web technologies "creates an aura of sophistication and high-tech ability" that may not represent the "quality of care at the hospital."

2. Is the particular use or application creating any value? Just because social marketing tools are cheap to implement doesn't mean they should always be utilized. The "we have nothing to lose" argument does not apply. And, even though web conversations are occurring anyway doesn't mean you must always be an active participant. Clearly, the people behind the social media push are gaining notoriety but less clear is the pay-off for the hospitals they represent. For every patient that might be impressed, there may be others who are dismayed.

It's a fascinating time in the world of marketing and communications. Yet, while we create new tools and channels, we'll need to ensure they accomplish what we intend.

A Spokesperson Goes Off Track

Remember to Keep an Ear to the Rail

Brands have several options when it comes to gaining endorsements. Among them are experts, celebrities, and people with actual success stories. In the pharmaceutical industry, the last example would be happy, grateful patients. Patient spokespersons have proven effective in communicating key messages authentically.

But not always. In "A Celebrity Patient's Backing Turns Sour for Drug Company," by Shirley S. Wang in The Wall Street Journal, we learn about Andy Behrman and his relationship with Bristol-Myers Squibb. Mr. Behrman is a well-known figure; he chronicled his life with bipolar disorder in "Electroboy: A Memoir of Mania," published in 2002. Reports indicate that BMS paid him $400,000 in 2004 and 2005 to discuss the benefits of their blockbuster drug, Abilify(R). Mr. Behrman appeared in videos, at BMS events, and in various media interviews, sharing how Abilify was life-changing and had no side effects.

Now we hear from Mr. Behrman, whose non-disclosure agreement has lapsed, that what was reported wasn't true. He stated that he experienced side effects worse than any treatment he had tried and stopped taking Abilify within the first year.

Working with endorsers can be tricky, but BMS reportedly said that every collaboration, except for this one, has been positive. Indeed, the first celebrity campaign—for the arthritis drug Voltaren(R)—gave CIBA-Geigy (now part of Novartis) quite a pain in the late 1980s. Baseball legend Mickey Mantle, who wasn't taking Voltaren and didn't disclose the corporate relationship, went about as far off message as one can go by claiming the drug can cure hangovers!

The WSJ article provides insights on how to minimize the chances of being surprised and disappointed by a patient spokesperson. Here are some principles to consider:

• Don't talk in absolutes. When he switched to Abilify, Mr. Behrman said that all of his drug side effects "went away." This assertion was made repeatedly and never should have been sanctioned by BMS and its PR firm. While Abilify may have a better safety profile than some other atypical antipsychotics, it carries a long list of side effects and warnings on its label.

• Ensure authenticity. The BMS contract didn't require Mr. Behrman to take Abilify yet there he was talking up the benefits.

• Conduct due diligence. Mr. Behrman signed a waiver allowing his doctor to share his medical records but BMS never checked them.

• Communicate good news and bad. Although Mr. Behrman said he was in almost constant contact with BMS and its PR firm, the bad news that he was, in fact, experiencing some side effects and stopped taking the medication was either ignored and/or never brought to a higher level.

• Be prepared to jump the rails. It's hard to pull the plug on a program, an investment, but that's what we must do when things go dangerously off track.

Staying the course may damage BMS's reputation, and Mr. Behrman's reversal might raise questions about his motives. His website includes a link to The Daily News gossip column, Side Dish, from November 19, 2008, which stated that Brad Pitt and Matt Damon might be interested in his new book, Adventures in the Drug Trade: I Was a Big Pharma Pusher. So, is Andy Behrman an honest whistle-blower or a calculating opportunist? Has he been overtaken by his illness again? These are questions we might not ask if more thought, care, and scrutiny had gone into the communications planning and review process.

Good - Not Great - News on Pharma Reputation

Hold the Champagne for Now

You may have read of the recent Harris Interactive Reputation Study that showed that "the overall reputation of Corporate America has never been worse in the eyes of the general public." The bright spot in the report? Surprise! It's the pharmaceutical industry.

Pharmaceuticals posted their highest rating in five years -- up to 31% in 2008 from 26% in 2007. Is this the beginning of a turnaround? Is the public perceiving more value in the discoveries and treatments from this critical industry? Maybe, maybe not.

To place this in perspective, we can look at what else transpired in this time frame. With bank failures, AIG, home foreclosures, executive bonuses and Bernie Madoff, the financial services industry has fallen into the reputation cellar with the tobacco industry. Both share an 11% positive rating by the public. And, there's the auto industry. It suffered the largest decline (22%) in the survey's history. So, while there may indeed be some reason to cheer, the uptick for pharma may be a case of looking good by comparison. And, remember, 31% good means 69% not good.

I'll hold on to some hope, though. This increase in Harris' "Reputation Quotient" was observed during a time of high-profile drug withdrawals, the Presidential election (which included industry bashing from both sides) and the largest average price increase in five years. Something went right for the industry.

During this time, also, was a steep decline in DTC advertising -- a drop-off of 8% in 2008, which followed a 4% decline in 2007. Is less DTC advertising inversely proportional to pharma reputation? Or, is this pure coincidence? I wish I had some data to share -- this would be an interesting phenomenon to study.

What I can tell you is that I have a hunch that these facts do have an association. I've been saying for years that, while some efforts do a great job of informing and educating, DTC advertising can trivialize side effects, create false hope and interfere with an individual's calculus of risk/benefit. In addition, the pervasiveness of some ads has fueled the perception that increases in promotional spending come at the expense of research and development. Indeed, at the end of last year Roche CEO Bill Burns said, "DTC advertising has been the worst decision for the drug industry. When industry says we're spending all the money on R&D, but actually it's spending it on TV advertising to preserve margins, it doesn't get much credibility." And, more recently, concerns have been escalating over the appropriateness of some ads (e.g., ED spots during "family hour").

Here's a case where less really could mean more. Fewer shot-gun approaches to advertising and fewer goofy stunts in an attempt to start a discussion may lead us back to more effective communications that improve relationships with stakeholders and enhance industry reputation.

Swine Flu's Teachable Moment

An Opportunity for Public Health and Vaccine Manufacturers

It was disturbing to read about a growing public health threat in "Vaccine Refusal, Mandatory Immunization, and the Risks of Vaccine-Preventable Diseases" in this week's New England Journal of Medicine (Omer et al.). The bottom line is that there is a critical need for new education and policy efforts to protect children (sometimes from their own parents) and the general public.

Here's an example of some of the bad news: In the case of measles, it's been estimated that more than two million cases occurred each year in the U.S. before a vaccine was available. In a triumph of science and medicine, the number of cases dropped to a mean of 62 per year between 2000 and 2007. In the first four months of 2008, however, 64 cases were reported with 63 of those occurring in children who were not vaccinated. Why?

• Past success. With a number of diseases nearly wiped out by vaccines, it seems as though our memories have been wiped out as well. As time marches on, many have forgotten the potential severity of vaccine-preventable diseases. Using the measles example, some cases can cause pneumonia, seizures, meningitis or even death.


• Alternative medicine and junk science. Of course, "western medicine" does not have all the answers. But it's been reported that parents of unvaccinated children "were more likely than parents of vaccinated children both to have providers who offered complementary or alternative health care and to obtain information from the Internet and groups opposed to aspects of immunization."


• Ease of opting out. Although the constitutionality of mandatory immunizations has been upheld, individual states have the ability to set the bar and allow exemptions based on personal or religious beliefs. In another unfortunate example, "the mean annual incidence of pertussis was almost twice as high in states with administrative procedures that made it easy to obtain exemptions as in states that made it more difficult." It was reported also that children with exemptions were 35 times more likely to contract measles.


• Denial. Compared to parents of vaccinated children, significantly more parents of unvaccinated children believed their kids had a low susceptibility to diseases (58% vs. 15%) and that the severity of disease was low (51% vs. 18%).


• Lack of trust. Again, compared to parents of vaccinated children, significantly more parents of unvaccinated children believed that vaccine efficacy and safety were low (58% vs. 17%, 60% vs. 15%).

Although the hearts of parents who withhold vaccinations from their children for non-medical reasons might be in the right place, their brains are not. In the "rugged individualism" that many Americans use to define themselves, there is a consequence of putting others in harm's way. Those who are unvaccinated put their communities at a higher risk of disease outbreak.

Now, there's a race to develop another vaccine -- this one against the swine (H1N1) flu. Although no one wants a new disease to contend with, there may be a silver lining -- a chance to reengage the public on the importance of immunizations. No doubt there will be an educational push when the vaccine is available. But at the same time, a campaign should be tied-in to reverse the dangerous growth of vaccination exemptions.

No vaccine is risk-free and not every mind can be changed. Still, the CDC (with their reach and clout), vaccine manufacturers (who can gain sales and reputation) and health care providers (who are a trusted source and carry influence on family health care decisions) should join forces to develop a new dialogue with the public. And let's sustain the discussion, let's put the science and evidence in perspective, and let's build some trust.

A Report Card on Report Cards

Why They Don't Always Measure Up

The run-up to the Obama administration's 100th day in office was truly a spectacle. It seemed that every media outlet had a countdown clock to April 29th and massed panels of experts to give the still new President a grade. The Report Card phenomenon has grown wildly in recent years. On the political side, a Google search of "President Obama Report Card" yielded 23,900,000 hits whereas "President Bush Report Card" produced 10,800,000. A crude yardstick, sure, but what makes this even more lopsided is that it took about three percent of the time (100 days vs. eight years) to double the number of hits.

We love to grade and that's fine by me. Measuring success is crucial -- in politics, business, health and medicine, sports, everywhere. There are some problems, however, and we need to ask a few important questions in order to place any grade in perspective:

• Who is grading? We need to consider the source, and determine their qualifications and potential biases. The "experts" gave the President every grade from A to F.


• What are the conditions? An honest appraisal of the environment is necessary in order to compensate for those issues and conditions that are beyond the control of the person being graded.


• How are grades being assessed? The scale must be the same, applied and then evaluated in an identical manner to all in the sample population -- all of the politicians, restaurants, doctors, etc.


• What are we measuring and how much weight should be assigned? The issues or subjects to be graded and for how much they count should be determined in advance. A post hoc analysis isn't fair or valid. In school, classes have levels and we multiply the grade by the number of credits. For news media consumption, this would get complicated. But some discussion of how outcomes are weighed should be attempted. Does reversing the ban on Federally-funded stem cell research count more, less or the same as closing the Guantanamo prison camp, filling Cabinet posts or passing the economic stimulus bill?


• When is it time to grade? Like defining the measurement scales and methods of analysis, the grading timeline should be predetermined. We've seized upon the 100 day mark but, in Washington time, that's practically light speed -- probably not the best time to hand out a report card. Many pundits ended up giving the President an "incomplete" because so many initiatives were in progress (though it would have been more accurate to say, "it's just too early but here's what the trend looks like.").

In days leading to April 29th, the President's staff repeated the message that 100 days is just a number, it's arbitrary. But what did we see on that Wednesday night? The President took the prime time stage to grade himself. Rather than dismiss the inevitable, he saw an opportunity and leveraged the milestone. The President used his position to choose the parameters, select the subjects and weigh the outcomes. If nothing else, and no matter where you are along the political spectrum, that should get a high mark for public relations.

The Secrecy Bucket is Full of Holes

Get Used to It

The following was published in PRWeek:

The FDA has been under fire for years. Approvals are too slow. No, approvals are too fast. Inspections are not rigorous enough and enforcement is too weak. No, FDA is over-reaching. There's too much interaction with industry. No, there's not enough. This push and pull has been played out in Congress, in the industries that FDA regulates (or hopes to regulate), in advocacy organizations and in the news media.

How do we know so much about some of these sharp divisions and controversies? It's because there have been loads of information leaking out of the FDA -- internal disputes, data allegedly ignored and stories of staffers being pressured to make various decisions. To plug the holes, Acting Commissioner Frank Torti sent an internal memo last month reminding staff about the types of information that must remain proprietary. Want to guess what happened next? Yup, the memo was leaked (and criticized by those who believe such a memo inhibits transparency).

Dr. Torti sent a farewell memo the other week to FDA staff which -- no big surprise -- was leaked, too. (He is returning to Wake Forest University to make room for incoming Commissioner Margaret Hamburg.) Despite the roiling atmosphere, he had some interesting perspectives and high praise to share with the agency: "The FDA is now defined by others. You must speak up and take the FDA back. It's yours, not theirs. You do more good day in and day out than most others, inside or outside of government." He added that, "what's written about the FDA is always from the outside, and I wish there was a way we could communicate what we've done, sometimes under very difficult circumstances."

I see three key points. First, the FDA has, indeed, lost control of its message. Regaining its public relations footing is possible but the agency is in a tough spot: dealing with hugely complex issues that can defy the sound bite, being overseen by elected officials eager to score political points, walking a tightrope trying to balance on the safety and efficacy of new drugs and devices, the list goes on. And when they tried to get some PR help late last year, it backfired. They were taken to task for awarding a no-bid contract.

Second, while transparency is crucial (as I have written here in the past) it cannot be used as a blunt instrument. There really are secrets that must be kept, at least for some period of time. Premature release of information can create a panic among patients in the case of drugs and devices, or among the entire public in the case of food. Or, there may be patent issues or patient information that demand confidentiality.

Third, we need to examine just how much secrecy we should expect these days. Our interest in inclusion means more people are exposed to secrets. More people means more mouths. And with people involved in social issues in addition to work, they often feel forced to choose sides. I can remember working for Roche and getting a call from an HIV/AIDS activist asking me to confirm some data that the company had sent down to the FDA just hours earlier.

The push toward more secret sharing is bound to accelerate. We have a generation growing up on Facebook, MySpace and Twitter, and all the other generations are aching to catch up. The amount of personal information people are willing to share is stunning. Clearly, the need to unleash our inner narcissist has overpowered our interest in keeping information private. A secret isn't what it used to be.

When an Ethics Company Does Wrong

Lessons From Coast IRB

Some of you know that I've been teaching Research Process & Methodology one night a week this semester at NYU's M.S. program in Public Relations and Corporate Communications. One of the concepts we discuss is confidence - what it means to have confidence in results, how to achieve it, how to measure it, how to determine the amount you actually need. The first thing we started out with, however, was ethics. Indeed, all of the students must pass a test given by NYU's University Committee on Activities Involving Human Subjects - the school's Institutional Review Board (IRB).

Special treatment on the subject of ethics in public relations? Yes, we're serious about this. The fact that some think it oxymoronic is, in fact, a crisis in confidence. With less than solid ethics, we risk creating a false or negative impression of ourselves, our business and our clients.

Ethics and confidence. Everyone knows that they exist in proportional units - the more the ethical behavior, the higher the confidence we have in the message, product, person, whatever. It's all part of the corporate reputation equation. Yet, each day we find new ways to rip ethics and confidence apart.

This is where we come back to the IRB. If there's ever a place where ethics and confidence should be at their most high, it's with research involving human beings. Unfortunately, such was not the case with Coast IRB of Colorado Springs. Federal investigators from the Government Accountability Office (GAO) concocted a fictitious clinical trial for a made-up medical device and attempted to get several IRBs to approve the study. Coast was the one that got out its rubber stamp.

Coast's press release last month said the Company had uncovered a "Congressional 'Sting' Operation." And, in testimony last week to Congress, Coast's CEO, Dan Dueber, complained of "extensive fraud" by the government. But the tune has changed. Now on their web site, Dueber says, "Coast IRB is cooperating fully with the Food and Drug Administration," and that efforts are underway to change "everything" and revamp "every aspect of the company."

Fortunately, no one was harmed although this episode called into question the hundreds of other studies Coast had approved. Those studies are continuing though Coast is banned from approving any new studies or adding patient volunteers to existing studies until the company can be brought into compliance.

Some of the key points I see are:

• Follow through on your promise. Coast IRB says its mission is "to protect the rights and welfare of subjects in clinical trials by providing and ethical and thorough review in a timely and efficient manner." Mr. Dueber, please review.

• Take responsibility. The Company's first reaction was to shift the blame - to the GAO, no less. If you're a company built on ethics, stick to the code.

• We need ongoing monitoring and reporting. Ethical codes stand only as long as there is a commitment to the enforcement of those standards.

• What's best for your audience, your customer, is what's best for you. James Grunig put it succinctly in his Symmetrical Communication model: the organization must consider the public interest to be at least as important as its own.

• Attempt to reassure and apologize. I did not observe any effort to address the hundreds of investigators and thousands of patients participating in Coast-approved trials. Try showing some empathy.

Disclosure - Keep It Coming

Try to Avoid Taking Two Steps Forward and One Step Back

Slowly but surely, pharmaceutical companies are stepping up. Unfortunately, at times (too many times) it's been painful to watch the industry progress toward a more open and transparent orientation.

On the good news side, Pfizer announced that it is the first pharmaceutical company to be accredited by the Association for the Accreditation of Human Research Protection Programs (AAHRPP). This helps to ensure the ethical treatment of clinical trial volunteers no matter where the research is conducted. The accreditation process is rigorous and took 15 months.

On the bad news side, this is 2009. Reports of unethical clinical trials have been popping up for decades. Indeed, Pfizer said that "AAHRPP accreditation is another step in Pfizer's ongoing efforts to earn public trust for integrity in research." So, why has this taken so long and why is Pfizer the only pharmaceutical company to mark the milestone so far? The AAHRPP has been awarding accreditation to programs since 2003.

This reminds me of the years that it has taken for pharmaceutical companies to post information about their clinical trials in public databases. Even after it was reported that a number of pharmaceutical companies were cherry-picking data from selected clinical trials that favored their investigational products, there was intense resistance to disclosing the existence of the previously unknown studies. Only after exposure in the news media and threats from Congress did the industry acquiesce. And still there's a steady flow of news about critical information being withheld here and there from the FDA.

There's just too much kicking and screaming, and it's not only about the progression toward more openness. Think of the history of the Medicare drug benefit, or instituting reforms on gifts and promotions.

The industry is full of smart, driven and ethical people, and they are supported by a lot of smart, driven and ethical consultants. I'm sure that they all recognize that the best way to run a business and to manage an issue is to move the information -- good or bad -- out quickly. More often than not, it's the tone and timing of the message that matters more than the severity of the issue. In practice, though, it's a different story. Of course, there are legitimate secrets and there are sometimes limits on what can be said. Still, we see companies (and governments and all manner of institutions) undermining their reputations by dribbling out crucial information over long periods of time.

There are lots of issues out there. Many companies are good at taking stock of their situations, writing extensive Q&A documents, developing "what if" scenarios and building advocacy networks to support their positions. But a lot of companies stumble on the next step -- getting out ahead of the issues. They're coming, you can see them. So, step over them, step around them, confront them head on, whatever. Just don't get run over again.

The World's Shortest Diet Book

It's All There in Clear, Concise Messages

I went to my local bookstore the other day to look at the management and leadership books. It was a mission to do a little competitive intelligence, since I'm working on one myself. (Yes, I do think there's room for one more! And if you know of an agent or publisher willing to work with a first time book author let me know.) On the way to my target, though, some catchy titles in the aisle of diet and weight loss books caught my eye. I diverted over there and... yikes. What a mess. How could anyone make heads or tails out of all the claims and contradictions?

Could this be an opportunity to work on a second book? Could I retrieve some of my long ago training in nutritional biochemistry, and meld it with my career in communications and passion for health and science literacy?

There's a huge need to be sure. The National Institute of Diabetes and Digestive and Kidney Diseases reports that two-thirds of U.S. adults are overweight or obese and nearly one-third are obese. Attempting to meet this vast market are the hundreds of fat-burning, colon-cleansing miracle products seen in advertisements and infomercials, and the thousands of books that claim to be the solitary answer to such a vexing and pervasive problem. (Message to the FTC and FDA: please help protect a desperate public from these purveyors of junk science.)

So, I got serious for a moment but then realized that I couldn't put an entire book together. I couldn't even think of enough material to fill a page much less a chapter. Why? Because it would be the world's shortest book. In my view, it all boils down to four words:

Eat less. Exercise more.

As communicators, we're taught to make the messages few, simple and memorable. I think I aced that test with my book title and book in one.

OK. Maybe there's a little bit more. There are different body shapes, different rates of metabolism, different personality types as well as economic issues. Unfortunately, when trying to stretch a dollar, junk food can often fill the belly at a lower cost. There are some people who must have a thorough medical examination to search for underlying causes of weight gain, and others who need some intervention to help them get jump-started be it through counseling, pharmaceuticals or surgery.

But the formula is pretty simple, nevertheless. If you don't put enough gas in your car, it dies while you're driving. Put too much in when it doesn't need it, you have an overflowing, dangerous mess. The key, therefore, is balance.

Michael Phelps, the record-shattering swimmer, gives us balance in the extreme. Did you happen to see one of those "up close and personal" vignettes from the Beijing Olympics where he was eating one of his meals? It was like Nathan's hot dog eating contest came to Animal House. Anything and everything was going down his gut. Yet, he's won more medals than anyone in history and hangs in poster form in many a teenager's room. He balances the ingestion of 10,000 calories with 10,000 worth of exercise.

I know my message is simplistic and I know also that the execution is not always so easy. Our bodies and our lifestyles change with age. Keeping in balance gets harder. We all know that we should eat a nutritious, varied, well-balanced diet. So, if one key is balance the other is expectation. We need to take the long view and not hope for or plan on a rapid reduction in weight. The goals must be achievable and bite-sized. With this in mind, I should double the length of my diet book:

Eat a little less. Exercise a little more.

Out of This World PR

This article also appears in odwyerpr.com.

How a Comedian Outwitted Some Rocket Scientists

I have been fascinated by our space program for as long as I can remember. Indeed, one of my earliest memories was watching John Glenn lift off in Friendship 7 in 1962 and seeing my mother cry. She said she didn't know if he would make it back.

Yes, spaceflight is serious business. But Stephen Colbert, the outstanding political satirist of Comedy Central, knows how to send us over the moon at NASA's expense.

You may have heard that NASA launched an on-line contest to help name a new module (now referred to as Node 3) for the International Space Station (ISS). Hoping to follow the tradition of naming past modules with lofty, cosmic names (Node 1 was named Unity, Node 2 was named Harmony), NASA opened up voting with Earthwise, Legacy, Serenity and Venture. They also allowed write-in votes.

Here's where Mr. Colbert comes in. This man is the Donald Trump of comedy. He has already managed to get a new species of spider named after him (Aptostichus stephencolberti) and a flavor of Ben and Jerry's ice cream (Stephen Colbert's AmeriCone Dream). In 2006, he asked viewers of his show to submit his name to Hungary's Ministry of Transport for their on-line effort to name a new bridge over the Danube River. It was reported that Colbert won the first round of voting with over 17 million votes. I should note that the population of Hungary is about 9.9 million. The Ministry then changed the rules.

For the NASA contest, a total of 1,190,437 votes were cast. Colbert scored 230,539 votes, outscoring Serenity by more than 40,000 votes. So, what does NASA do? Well, according to Space.com, agency personnel are floating the idea of naming the Station's new toilet in the module "Colbert." This is proof that NASA should stick to space and aeronautics and not venture into comedy. A Colbert space toilet isn't funny - I think it's demeaning.

Although the rules of the contest state that "the results are not binding on NASA" and "NASA reserves the right to modify these Contest Rules at any time," what happened to fair and square? But being an optimist, I'm wondering if there's a win-win in this somewhere.

NASA has abbreviations and acronyms for everything, so why not now? Here's my idea: For Stephen T. Colbert, let's come up with something space-like using his initials. Node 3 could become the STC - Serenity Transorbital Compartment. Or something like that. NASA gets to use the Serenity name and Colbert gets his initials immortalized (at least until the ISS burns up in the atmosphere after its service life is over).

NASA could embrace this situation. Why not invite Colbert to tour the STC mock-up or to the actual launch at the Cape? Why not have him on a video link with the orbiting crew during the taping of his show? Sure, he'll make fun and get some laughs but these would be sure fire ways for the agency to make science more accessible and gain a huge audience.

So, I've done my part to help solve this planetary crisis. Now it's time for NASA to learn a few communication tips:

• Don't ask for something that you don't want to hear.
• Changing the rules makes one look like a sore loser.
• In the age of on-line vote stuffing, enforce the one person, one vote rule.
• Plan strategically, and think through the intended and unintended consequences of any action.
• Play to your strengths - science not satire.

Healthcare Journalism Needs a Recovery Plan

There’s More Evidence That the Profession is Suffering
I’ve spoken out before (Give Me an S, Give Me a C, Give Me an…, Personalized Promise, Heading in the Wrong Direction, NEJM Makes It Official) on the need for increased health and science literacy. This is crucial if we are to promote evidence-based decision making, increase productivity, enhance economic competitiveness and ensure the continuation of the democratic process. The Obama administration is sending the right signals but a survey of health care journalists conducted by the Kaiser Family Foundation and the Association of Health Care Journalists shows that the state of health and science media, like the economy, may not have turned the corner quite yet.

In response to the question of “what do you think is the biggest opportunity in the field of health care journalism?” the number one response was the “ability to educate and empower consumers.” Great. But overall they expressed concern about “staff cutbacks, less time for reporting, fewer resources for training, and more pressure to produce short, quick hit stories.” Almost all (94%) said bottom line pressure hurts the quality of health news. Sixty-five percent judged the quality of health coverage as fair or poor, and only one percent said it was excellent.

Even so, respondents had “a cautiously optimistic view of the direction in which health journalism is headed.” While 24% said journalism in general was heading in the right direction, the number jumped to 52% when asked specifically about health journalism. This didn’t give me much comfort, though. That still left 48% who thought health journalism was heading in the wrong direction.

It’s been noted that as the amount of health and science information has grown, the amount of time and space devoted to them has shrunk. This has created opportunities for non-journalists to jump in but I, for one, don’t want to see this gap filled by consumer-generated content alone.

As for the type and placement of health and science stories, the trend of focusing on political or business angles will continue. And with the politicization of healthcare – be it Medicare, Medicaid, FDA, stem cells or pharmaceuticals – it was not surprising that the business/economics of health care, health care quality and performance, and health policy were all ranked higher than medical research and science as areas where more training was needed.

Healthcare journalists are hungry for ongoing opportunities to elevate their knowledge and skills yet 43% said training opportunities have declined. Twenty percent said opportunities increased. In a report to the Kaiser Family Foundation written by Gary Schwitzer of the University of Minnesota, a radio reporter said, “My biggest challenge is having enough background and training to cover health care. This is an incredibly complex and challenging beat. People are pitching stories left and right and if you don’t have a way to analyze their claims, you could be doing your listeners a big disservice.” To be sure, the proliferation of junk science continues to give me great concern.

This less than rosy picture comes to us despite the availability of some terrific training programs, workshops and “boot camps” underwritten by various foundations, government agencies and companies. I hope that even more can be done, and find ways to help journalists get the time and resources to attend. Indeed, 69% of the respondents reported that opportunities for travel declined in the past few years.

Maybe this will all turn around with time. I’m going to hope that we’ll see demand for health and science reporting increase as we continue to shake off some of the anti-intellectualism that has bogged us down. I’ll hope that we’ll see more public and private investment in training and continuing education. And I’ll hope that we’ll see some newsrooms staffing up as the economy recovers.

New Bedside Manners

Tell Me – Not the Internet – How You Feel
I haven’t conducted a formal survey but I’d be willing to pull some money out from under my mattress and bet that two of the most often-used words these days in the worlds of business and politics are transparency and accountability. There’s been little choice, if you think about it. The collision between out-of-control companies and politicians with public outrage and instant communication tools has sparked unprecedented demands for truth and openness.

The push to expand transparency and accountability has given rise to numerous rating sites on the internet – everything from food to teachers to virtually any product. This long list includes about 40 web sites where one can rate their healthcare provider.

In an AP story last week, “Docs seek gag orders to stop patients' reviews,” Lindsey Tanner reported how some physicians are coping with anonymous, negative patient commentaries on sites like RateMDs.com. Intrigued, I went to the web site and saw that over 185,000 “doctors” were rated, but this includes acupuncturists, chiropractors, podiatrists, psychologists and dentists. I clicked on the most reviewed doctors and found that the top four are ob/gyns and number five is a cosmetic/plastic surgeon. (Number six, I must note, is the fictitious Dr. Gregory House.)

It’s not a big surprise that women, the most influential healthcare decision makers in the family unit, are the most vocal. Randomly scrolling through, I found some posts to be reverential and others to be scathing. These comments are a one-way street, however. The doctor’s name is used but not the patient’s and, because of rules protecting patient confidentiality, there’s no way for the doctor to respond.

Here’s where a company called Medical Justice comes in. For a fee, they offer physicians a service that monitors the internet for patient comments and a contract (“mutual privacy agreements”) for their patients to sign where they “agree not to post about their doctor on the Web without the doctor's permission.” In addressing First Amendment rights, the site states that “Patients are free to discuss their care with other doctors, family, friends, licensing boards, attorneys, and any number of institutions. Mutual privacy agreements do not create a choice between healthcare and one's right to free speech (as some have erroneously claimed).”

So, on one hand we have sites that allow unfettered forums for blasting (or praising) health care providers. On the other hand, we have an effort to limit where patients can express their views. Here are a few thoughts:

Health care providers need to accept the reality of our information society. Telling someone they can’t do something is a sure-fire way to promote the opposite of what is intended.

Entering into a contractual arrangement with a patient over issues of speech may raise questions about the doctor’s motives, potentially damage the relationship and erect a barrier that decreases communication.

If women are using this medium most frequently, then some special attention needs to be paid to their concerns and communication preferences. There should be an office environment where concerns can be aired before they hit the internet. And, if face-to-face commentary is uncomfortable, perhaps an anonymous mail-in survey should be made available.

While both sides have legitimate positions, I think we require a third hand. What’s needed is a forum where patients can post justifiable comments, where those who read them can have some assurance that no axes are being grinded. Health care providers need assurance that inaccurate, reputation-killing commentary is kept off the web, where it’s so difficult to excise.

Patient advocates and organized medicine should collaborate on setting standards and policies – a code – for responsible, ethical rating sites. Both patients and their doctors need to get on the same side of the fence on this issue. When it comes to your health and wellness, I can’t think of an issue where it’s more important for all the parties to act as a team.

Knowledge Base

Perspectives on the State of Research Readiness in Public Relations
The following was published in the March 2009 issue of PRSA’s Tactics:

I recently finished teaching the Research Process & Methodology course at NYU’s master’s program in Public Relations and Corporate Communications. Serving as an adjunct professor is a great outlet for the coaching and mentoring that I’ve missed since becoming a communications and business development consultant in 2006. But this particular experience left me a bit unsettled. It drove home the fact that research remains a weak link in the development, execution and evaluation of PR programs.

Becoming Involved
I was invited by my friend and the academic director of the NYU program, John Doorley, to guest lecture within the program and later teach the Strategic Communication course. Then came a request to teach Research Process & Methodology.

Here, however, I had some reservations. Like Strategic Communication, RP&M was mandatory, but this was a subject that most students dreaded. We were to cover qualitative research, including interviews and focus groups, and quantitative methods such as sample selection, questionnaire design and data collection and analysis. The objections were along the lines of, “We’re the creative people, not number crunchers. We’re supposed to be intuitive — that’s why people hire us!”

Even though I had the feeling of being dropped behind enemy lines, I was energized by the opportunity to convey the need for more rigor in PR programming. Now, more than ever, it is necessary to identify competitive, political and social issues; understand key audiences, their preferences and perceptions; differentiate companies and products, and demonstrate the value of communications on business objectives and measure outcomes.

Clients crave creativity but they don’t want guesswork. To be effective, we need information to drive insight. If PR professionals want to be strategic, then research is required to help make the best possible predictions about the potential intended and unintended outcomes in PR programming.

Getting Down to Business
Most of the students’ anxiety was assuaged soon after starting the first class. Setting unambiguous expectations and goals were key. I made it clear that I did not intend to transform them into statisticians or programmers. Instead, they would become more informed users and evaluators of research. To reach this endpoint, and to keep the students engaged for the six hours per week that we met, we worked to strike a balance between theory and application — a mix of book learning with in-class exercises.

In one class, we reviewed and evaluated a variety of award-winning PR case studies including corporate rebranding, the launch of new products and national events. They were eye-opening — even for me. If these were chosen to represent the best work of the industry, the pinnacle of public relations, then we — the profession — had some work to do. Why did those objectives look like a bunch of tactics? What did “we achieved a high level of buzz,” mean? Was the result at all meaningful to the business? One hundred million impressions is a big number, but did the message reach the intended audience?

This analysis helped make the research process more real, more accessible. By the end of the course, the role of research in public relations was duly elevated in the minds of the students. They didn’t leave with a list of formulas memorized, but they did leave knowing how to ask good questions and take their place at the table of strategic PR planning.

Taking the Next Step
While feeling rewarded by the response of the students and the opportunity to connect with some terrific guest experts, I was left with some concerns. After I reviewed the final projects — detailed proposals for their Capstone papers — and posted the grades, I wondered about the state of research training in PR agencies. How do these firms really value research? What expectations do they have of the staff? How is research taught in other programs outside NYU?

I decided to send a three-question survey to the top 25 agencies. I inquired if they had an in-house training program, which courses they offered and if any were mandatory. Only eight of 25 surveys were returned — perhaps these were the firms that were most proud of their programs.

However, the results were still revealing. As one would hope and expect, 100 percent of the respondents offered a variety of courses and workshops. All of the agencies had programs in the traditional areas of public relations: writing skills, presentation skills and media relations. Some offered training in issues/risk/crisis management, advocacy/third-party relations, conflict resolution and digital media.

On the other hand, only three of eight said some or all classes were mandatory. I found this to be both surprising and disturbing. Competitiveness, differentiation and excellence are all based on learning.

When it came to metrics and numbers, the story did not improve. Only half of those responding reported that they offered training in research methods and/or measurement. Respondents at 50 percent of these agencies offered courses on budgeting and/or forecasting. I wasn’t hugely surprised by these answers, as I’ve known for a long time that numbers and words don’t mix for many PR practitioners.

But it’s time to push old habits aside. Indeed, these tough economic times reinforce the importance of numbers. “Good enough” is out. Precision is in. Of course, creativity and fresh ideas are essential. But we need balance: The same urgency that is placed on learning, thinking and executing the soft side of public relations must also be placed on the hard.

Hide or Seek?

It’s Time for the Healthcare Industry to Find New Footing
There's plenty of blame to go around these days. We’ve all seen angry fingers pointed at the tobacco companies for pushing products they knew to be hazardous and additive. There were hearings before Congress, lawsuits and some new restrictions on marketing to teens.

HMOs came under fire for denying medical claims and access to potentially life-saving interventions. Lawsuits and some high-profile reversals in coverage decisions ensued.

Big oil and oil speculators had us over the figurative barrel when a gallon of gas went over $4.00 a gallon. With the collapsing economy, gasoline prices have fallen by more than 50 percent (though the price of oil has fallen by more than 70 percent).

The list continues with the biopharmaceutical industry. Despite cost assistance programs, there are still too many patients who choose between filling a prescription and buying other necessities. They may not have insurance or their co-pays for medications may be enough to tip a limited budget into the red. There has been some relief with the implementation of the Medicare drug benefit and more has just been promised by President Obama in his address to Congress.

Now, there’s another group to vilify – the financial industry. Predatory lenders, over-compensated CEOs and Ponzi-scheming money (mis)managers.

Though sometimes pushed from the front page by competing bad news from the banking and housing crisis, there are still plenty of stories out there that help fan the flames on healthcare. And they’re not just about cost and access: law suits and investigations on drug promotions, side effects, data disclosure and fraud help to keep the fury fresh. (We all know that a healthy fraction of the drug, device and diagnostic industries’ low reputation is self-inflicted, but that’s a whole other discussion.)

All of this has helped to divert some attention away from the issues and concerns of those healthcare sectors that are involved with discovery and innovation. Indeed, true healthcare reform – expanding access, and improving care and efficiency – will be difficult to achieve unless we enhance our ability to detect, treat, cure and prevent diseases.

So, what kind of visibility should the biopharmaceutical, device and diagnostic sectors be seeking right now, especially when the chairs are empty at HHS, FDA, NIH, CDC and CMS? One option is to do nothing and enjoy the relative calm (compared to what the financial sector is experiencing). To some, it’s schadenfreude – a nice change to see public anger and resentment trained somewhere else. Another option is to fill the void with new ideas, new approaches and reengage our publics.

For a snapshot of the current messages coming out of the key industry trade associations, I went to their web sites. The most prominent feature on PhRMA’s homepage highlights Meredith Baxter’s battle with breast cancer. Also, there are links for prescription assistance, healthcare reform and medicines in development. Likewise, the AdvaMed web site has a number of links to interesting content. However, neither have a clean, clear set of rallying points. BIO is a little closer to at least part of what I think we need. There’s a CNBC interview with association president James Greenwood from their CEO & Investor Conference. He makes a clear connection between healthcare and the economy – the need to “expand access to health care while expanding incentives to innovate.”

Like housing, banking and automobiles, biotech is in a crisis. Perhaps this is one of the messages that needs to be amplified and expanded to gain more relevancy with more audiences. The scary facts are that a quarter of biotech companies have six months or less of cash. Half have 12 months or less. The editorial in the February issue of Nature Biotechnology remarks that “many promising products now face financial oblivion.”

Yes, we need healthcare reform to expand access. Yet, without the underpinnings of new research, and new diagnostics and therapeutics, we will lose the capacity to consistently improve health. The transformation from trial-and-error approaches to DNA-guided medicine, ensuring that we get the right medicine in the right dose, will be pushed back by who knows how long. And, our economic competitiveness, our lead in innovation, will wane.

Certainly, the public doesn’t want to hear that healthcare, like the other sectors mentioned above, is looking for a bail-out. But some heads need to come together and think about new ways to build support for a remarkable but hobbled industry.

The Latest Message War

This article also appears in odwyerpr.com.

The Fight to Win Hearts and Minds Over the Economy

The messaging wars are in full swing over the Obama administration’s plans to reverse the slide in the economy. The latest example is still playing out after yesterday’s commentary by CNBC’s Rick Santelli from the floor of the Chicago Board of Trade. (After hearing about it all day, I became the 220,884th viewer on YouTube.) In a nutshell, Mr. Santelli denounced plans to provide $75 billion to support certain borrowers (“losers”) who face foreclosure. He called for a protest – a “Chicago Tea Party” – against using taxpayer’s money to subsidize someone else’s (and not his) mortgage.

We’ve seen the sides line up. Earmarks, pork, and hand-outs versus stimulus, recovery and investment. Waste versus necessity. House flippers who got caught versus predatory lenders. Socialism versus pragmatism. It’s evident that the middle ground is missing.

Bills are moving through Congress but the process remains ugly. We need a diversity of opinions and ideas but everyone needs to take a quick breath. We need to try really hard to let go of personal agendas and focus on our collective goals. I know, I know, we’re talking about politics – by definition, there’s an agenda. But this situation reminds me of the kind of counsel we’re supposed to give as strategic advisors – tell the client what they need to hear – what’s good for their business – not what we want to tell them.

Clearly, Santelli's message struck a populist chord. We’re supposed to be responsible for ourselves, take responsibility and live with our mistakes. We’re Americans! Yes, fine. I’m with that. Yet, Americans have heart. We volunteer more than any other country. We find strength in our communities. We rush to aid others in times of crisis. Well, this is a crisis.

The messaging mavens are entitled to build whatever walls or bridges they want. In this mortgage crisis, though, it’s interesting to see how “subsidy” has become a dirty word. Here’s where a breath, some perspective, could help. We subsidize all the time. Look at the insurance industry. Non-smokers subsidize smokers. Motorcycle riders who wear helmets subsidize those who do not. Sober people subsidize alcohol and drug treatment programs.

Seventy five billion dollars is, indeed, an enormous sum of money and nearly no one wants to see us spend cash that we don’t have. The scale of all of this is unprecedented. It’s scary. But, it’s been said that desperate times call for desperate measures. That does not mean desperate behavior. When it comes to addressing our problems, we need rational minds crafting rational programs communicated in a rational way.

Betting on Vetting

This article also appears in odwyerpr.com.

Why We Need To Ask (and Answer) Questions
It happens every four years but also in lots of places in between. It’s the political vetting process.

Despite the development of an unprecedented process of detailed queries by the Obama administration (including a seven page survey with 63 separate requests for information), it’s been a banner year for viewing some high-profile nominees go down in flames. These include Tom Daschle for HHS Secretary and Bill Richardson for Commerce Secretary. Either the answers to the questions were inadequate or the vetters themselves were inadequate or both.

Sarah Palin, who remained on the GOP ticket after a much maligned shotgun-wedding-of-a-vetting process, might have been the most talked about case. Yes, there were the serious issues of her readiness to be a heartbeat away from the presidency, the ethics investigation in Alaska, her husband’s DUI arrest and her unwed teenage daughter’s pregnancy. But it communicated more. Reputations suffered. The unraveling episode was a reflection of the McCain team, and of the man himself and his judgment. Some argue that the Daschle and Richardson picks (and throw in Timothy Geithner and Nancy Killefer) cast similar doubts on the President.

Of course, this isn’t new. I’m not a political historian but just off the top of my head I can remember Thomas Eagleton for Vice President in 1972, John Tower for Secretary of Defense in 1989, Zoë Baird for Attorney General in 1993, Bernard Kerick for Homeland Security Secretary in 2004 and Harriet Miers for the Supreme Court in 2005. The reasons for these falls from grace are various, including mental health issues, tax problems, outright corruption and limited qualifications.

Politics is just the tip of the iceberg when it comes to the lack of vetting – just ask those who were ripped off by Bernard Madoff. It’s clear that questions should have been asked but I don’t have an answer on how to overcome blind faith or greed that blinds.

There are several points here:

Taking the time to ask questions – good questions – is essential. But equally essential is the need to receive good answers – truthful answers – in a timely fashion.

The truth will out. Being transparent and honest is the first, best – the only – approach. And, let’s face it, our 24/7 on-line world is relentless in its pursuit of a good story.

We must accept, however, that decisions must get made eventually and that time is often an enemy. The best decision-makers know when collecting more and more information leads to diminishing returns. We need to learn how to manage and accept risk.

If we are to wear an ethical mantle, then we must commit to ethical standards… all the time, not just when it’s easy or convenient or in public. And, we must ensure that those with whom we work or hire also adhere to those principles.

These lessons are not new to professionals in the communications field. Strategic communicators ask questions and gain insight through rigorous analysis of information. They look around the corners, predicting outcomes and the potential unintended consequences of a particular course of action. They prepare scenarios (from those with high probability but little impact to those with low probability but a high potential for damage) and engage in “wargaming” exercises. They develop comprehensive Q&A documents, and pay attention to language and tone. They determine, in advance, who might be an advocate and who might be an adversary. Once prepared, they move forward.

The call from Washington for more transparency and higher standards is a good thing. Openness and sharing information is what democracy is about. Perhaps some day down the road we might learn that sweeping bad or embarrassing news under the rug is bad business. If not, someone will always be around to ask, “What’s that lump under the carpet? Let’s see what’s there!”

A Pioneer Passes

Martin Delaney, HIV/AIDS Activist, Taught Us Much About Communication and Finding Common Ground

Martin Delaney was the founder of Project Inform, the San Francisco-based organization dedicated to providing “information, inspiration and advocacy for people living with HIV/AIDS.” Marty threw himself into this public health crisis because he didn’t want to sit on the sidelines while his friends were dying. (He was not HIV-positive; it was liver cancer that killed him at age 63.) His organization and others, like ACT UP and GMHC, changed the way we viewed HIV/AIDS and much more.

We met not too long after Project Inform was founded. I was in the Public Policy and Communications department at Hoffmann-La Roche and he was on the other side of the table. With anti-retroviral drugs in the pipeline, seeing the emerging influence of AIDS activist groups (and the break-ins and boycotts affecting Burroughs Wellcome, manufacturer of Retrovir®/AZT), and imagining the potential benefits of hearing the patients’ point of view, I pressed for engagement. I remember quoting Lincoln to my management: “As our case is new, so we must think anew, and act anew.”

There was no playbook. Pharmaceutical companies didn’t interact with consumers. The Company would inform the “learned intermediary” – the physician – and he or she would communicate with the patient. Marty helped to bury that dogma and enhanced the dialogue between all of the key stakeholders. The industry and the FDA grappled for years over ways to expedite the review and approval of drugs for serious or life-threatening diseases. Marty helped to change policy, and many thousands of patients were able to gain early access and benefit from new therapies. Information about new treatments, managing side effects, insurance coverage and the availability of clinical trials was largely uncoordinated. Marty helped to launch a well-regarded newsletter, town hall-style meetings, and an AIDS treatment hotline.

Interacting with Marty helped me to learn a key lesson: the importance of finding common ground. The world was changing. The normal course of business – the normal course of life – was disrupted. We, the industry, and the patient community approached our goals from different directions using different strategies and tactics but much of what we all sought was the same. Our constituency was their constituency and everyone wanted new medications on the market as soon as possible. The two “sides" worked jointly to expand drug access, enroll patients into clinical trials, renew R&D tax credits, and reauthorize the Orphan Drug Act.

It wasn’t always pretty. There were bumps in the road but at least we were on the road together, held there by mutual interest and mutual respect.

His lessons went beyond the HIV/AIDS community. I remember attending a meeting at PhRMA (then known as PMA) headquarters in Washington, DC. Expecting to see representatives from the AIDS advocacy organizations, the room included members of some just formed cancer patient groups. They were brought along to learn the ways of the pioneering AIDS organizations. It was brilliant.

Marty was dogged, built and expanded relationships, leveraged his network and communicated in new ways with a firm but calm approach. His contributions were many and should be remembered.

Great Expectations

Our Standards For Scientists and Physicians

Should we have higher expectations of scientists and physicians when it comes to admitting mistakes? What about ethics? At first blush, most of us would say, “Of course.” It’s about scientific objectivity. It’s about life and death. True. But there is a more complicated story here.

Some recent articles touch on the expectations the public has of researchers in the sciences. Sharon Begley of Newsweek (“On Second Thought…,” January 12, 2009) expressed some surprise that scientists are no more likely to change their minds than ordinary citizens when confronted with new facts. She writes that “based on a dispassionate evaluation of empirical evidence, they are expected to willingly, even eagerly, abandon cherished beliefs when new evidence undercuts them.”

Well, I’m disappointed more than shocked. The problem here is the word “dispassionate.” Who ever said scientists don’t have passion, or points of view or even biases? In other words, scientists might be highly educated and engage in laudable pursuits but they are human in every respect. And, being human, scientists can get locked into positions in the face of what others might term overwhelming evidence. As I wrote in Do the Facts Matter?, "If the facts don’t fit the person’s worldview or “frame,” as the cognitive linguist George Lakoff terms it, the facts bounce off like bullets shot at Superman’s chest.” It doesn’t matter who you’re debating, all the data get deflected while you get blue in the face. The bottom line is that insight alone does not change one’s mind. It’s the desire to change that propels us in a new direction.

Indeed, it’s passion that has led some researchers to involve their own children in their investigations. However, this passion – while responsible for pulling us forward and driving us to explore ever deeper – may cloud our judgment and create some unintended problems. In “Test Subjects Who Call the Scientist Mom or Dad,” Pam Belluck of The New York Times (January 18, 2009) interviewed Robert M. Nelson, director of the Center for Research Integrity at Children’s Hospital of Philadelphia who said, “The role of the parent is to protect the child. Once that parent becomes an investigator, it sets up an immediate potential conflict of interest. And it potentially takes the parent-child relationship and distorts it in ways that are unpredictable.”

The story also mentions Karen Dobkins, a UCSD psychology professor, who used her infant twins in a cognitive research study, who said, “it was kind of painful, because one of my twin boys basically played the game really well, but my other son, we couldn’t even use his data.” She said that “made me worry that he had autism.” Her worries proved unfounded. Still, she said, “I took only the good data and copied it and put it in both of their baby books.” (Of course, now those kids will know the truth when they’re older because their mother spilled the beans to The New York Times!) And there’s Pawan Sinha, a neuroscience professor at the Massachusetts Institute of Technology, who admitted that his wife (also a researcher) was “quite opposed to this idea of experimentation” on their son. He went on to say that “it had to be done surreptitiously, whenever she would go out or when I would take him out…”

What does all of this communicate to the general public? In addition to the potential warping of the parent-child relationship, our scientists are fudging their baby books and lying to their wives. It’s small potatoes, right? Some semi-innocent lapses? Wrong. In my head, at least, the alarm bells are going off. Where does one draw the line? If scientists are less than honest in these dealings, wouldn’t the public begin to doubt their credibility on the bigger issues? Would they change their results in a lab book, in a publication, in testimony? And, the matter-of-fact way these scientists discuss and rationalize their exploits sends yet another damaging signal.

The fact is that higher standards do exist for scientists and researchers. They have an imperative to protect the safety and rights of human subjects. They are compelled to disclose conflicts of interest and monetary connections that might create bias or the appearance of bias. They must obtain the approval of Institutional Review Boards who set and maintain ethical standards for research locally but must also uphold State and Federal statutes.

Yet, when it comes to maintaining integrity, there should be no differences between scientists and the general public. Baseball player or biologist, novelist or neurosurgeon, we should all adhere to the same standards in truth and honesty.

NEJM Makes It Official

The Role of Communications in Public Health
Communicating. It’s the first word on the first page in the first article of the first issue (of 2009) in what many would consider first among the medical journals, the New England Journal of Medicine. My first utterance upon reading this was, simply, “Wow.”

In “Communicating Medical News – Pitfalls of Health Care Journalism,” Susan Dentzer, editor-in-chief of Health Affairs, writes “Whether they realize it or not, journalists reporting on health care developments deliver public health messages that can influence the behavior of clinicians and patients.” This is the lead that the NEJM chose to use for its first issue of the year. Not healthcare reform, not science policy, not clinical strategy. Communicating.

The article is a terrific platform to tell (or remind) its learned readership that they have a critical role in helping journalists get their stories right. As Ms. Dentzer points out, the consequences can be dire. With inaccurate details or story angles developed for shock value, patients can be spooked out of taking their medication or not even seek medical attention.

And, it’s not good for business either. Innovators, entrepreneurs, investors and diagnostic, device and biopharmaceutical companies can all suffer from the herds prodded on by cowboy journalism. In the latest issue of Health Affairs (28, no. 1), it was reported that U.S. health spending in 2007 grew at the lowest rate in nine years, mainly because of slowing prescription drug sales. Why? The availability of generic alternatives was a major factor. But Federal health officials also said that the trend in drug spending was influenced by increased safety concerns.

The problem of health and science reporting is further exacerbated, Ms. Dentzer said, by the many journalists who “consider themselves poorly trained to understand medical studies and statistics.” She laments also the lack of time, comprehensiveness and context afforded healthcare stories.

OK, so this isn’t exactly news to us in the communications/public relations field. Some journalists are ill-prepared and misinterpret the facts. Some news outlets are chopping their staffs and, thus, preventing opportunities for deeper investigation. And, some scientists and clinicians can’t form a coherent sentence.

Beyond the call for better training of health journalists and asking the medical community to provide wider balance, however, we need a change of mind-set. Journalists, news outlets, content experts and communications professionals all share a goal – get important, compelling information into the hands – the minds – of the right people. Let’s learn from each other. Let’s communicate. The bottom line is that we need each other if we are to inform and motivate and create positive changes in behavior. Though there’s a long way to go, having the role of communications in public health elevated in the NEJM is a great way to start 2009.

Heading in the Wrong Direction

We Need More, Not Less, Health and Science Reporting

I’ll add my outrage to that expressed in a recent letter from the Council for the Advancement of Science Writing, National Association of the Science Writers, Society of Environmental Journalists and World Federation of Science Journalists to Jim Walton, President, CNN Worldwide and Jon Klein, President, CNN/US. Just as the in-coming Obama administration signaled its commitment to bolster science and technology investment and education, CNN sacked some of its most experienced science journalists and producers.

CNN’s timing could not be worse. We are in desperate need of another science boom and greater public support will surely help propel the effort forward. Our healthcare, our environment, our energy needs and our economy all depend on it. Thirty years ago, the US ranked third among developed nations in the proportion of college students receiving degrees in science or engineering. Now, we stand in 17th place. And, as I wrote in Personalized Promise, only about 10 percent of the US population knows what a molecule is, about 30 percent could define DNA and, shockingly, about half know that it takes the earth one year to orbit the sun.

So, we need more interest and understanding not less. We need more people informed, more involved, more inspired. And, we need more knowledgeable professionals sifting through the growing mass of information to communicate the progress and the failures, and differentiate the facts and evidence from the frauds and junk science. We need more, not fewer, players in the effort to enhance our science literacy.

And, it’s not just straight news reporting that we need. Knowledgeable and experienced reporters bring us perspective. It’s too bad that in 2009 CNN will leave it up to others to help us celebrate the 400th anniversary of Galileo’s first telescope and ask the questions about what new cosmic discoveries await us. Or, the 300th anniversary of Abraham Darby’s use of coke that revolutionized iron smelting and investigate what new alloys might build tomorrow’s structures. Or, the 200th anniversary of the first geologic survey in the US and its implications on the environment, mining and land management. Or, the 100th anniversary of Wilhelm Johannsen’s coining of the terms gene, genotype and phenotype that launched the language of genetics.

CNN, please reconsider. As we leave the era of anti-intellectualism behind, we should see an ever-increasing public interest in health and science, more progress and discoveries to report, and new or strengthened companies to buy advertising time on your networks.

Standards of Apology

This article also appears in odwyerpr.com.

Some Observations on the Siemens Case
The state of the apology is faltering. What was once a heartfelt gesture of contrition, the apology has become a tool – an attempt at collecting a “get out of jail free card” by out-of-control entertainers, sports figures, politicians and business executives. Its sincerity has been lost to statements calculated by attorneys and publicists.

Of course, there are still authentic and appropriate apologies out there. Real remorse is evident, real emotion is displayed and, sometimes, real tears are shed. But I’ve read some arguments that, in the U.S. at least, we’ve gone overboard – we apologize too much and too often.

There are some problems with that claim, however. Does every slight warrant an apology? Of course not. I believe that part of the perception of over-apologizing may come from the fact that the apologizer didn’t get it right the first time. He or she had to try it again a second or even a third time. And, with a prolonged news cycle, we may witness the same person answering the apology call multiple times. In addition, I’ve noticed an increasing usage of apologies as instruments of attack. These “weaponized apologies,” as I’ll call them, are used most prevalently by politicians as they deflect criticism and instead demand some reparation from those who crossed them.

But there was no over-apologizing in a huge scandal that just concluded in a $1.6 billion settlement. Siemens, the global engineering powerhouse with interests in the industrial, energy and healthcare sectors, had admitted to years of bribes to secure contracts around the world. “Bribery was Siemens’s business model,” Uwe Dolata, the spokesman for the association of federal criminal investigators in Germany told The New York Times. “Siemens had institutionalized corruption.”

The words sorry, apology or regret are not found in the 26 page press release issued on December 15, 2008 when the Company reached an agreement with U.S. and German authorities following a two year investigation. OK, fine. Still, it should not have taken 22 pages to read that “The Company’s top management is committed to transparency and ethical business…” On the last page of the release, we are told that the events of the past two years since the first arrests “while among the Company’s most challenging moments, served as a catalyst for significant, long overdue changes.”

Indeed, the tone of the Company communications was rather self-congratulatory. At a press conference held on the same day, Gerhard Cromme, chairman of the supervisory board, said that he was “pleased that the criminal proceedings… could be concluded” in “record time, only two years” and that the settlement amount was “below the numbers that were speculated.” And, he noted that U.S. prosecutors said Siemens had undertaken “exemplary investigative and remedial efforts.” The expansive inquiry and organizational changes, he said, could “be seen as evidence that the company’s course of clarifying its structures and change has restored trust.” More than seven minutes into a ten minute speech he said, finally, that “we deeply regret that wrongdoing occurred in the past. But we have done everything in our power to remediate past wrong doing and expose and eliminate its causes.”

Peter Löscher, CEO, later stated emphatically that “Siemens stands for clean business everywhere and always” and that “We stand not at the end of a process but at a beginning.” But, with only a glancing mention of their corporate values, there was a presumption that “all Siemens employees have regained a good portion of their self esteem and self respect.”

Siemens is a venerable company with 160 years worth of technological accomplishments, an astonishing 55,000 patents and 430,000 employees around the world. (In fact, I’m a big fan of their efforts to support science education.) This world-class company missed some opportunities, though, to make a convincing case that it was doing more than just cooperating with the authorities and going through the necessary motions to bring itself into compliance with the law. Yes, actions do speak loudly but so does the manner in which they are communicated.

Let’s Not Get Burned and Drowned (By Information)

Right, Wrong; Too Much, Too Little; Too Early, Too Late
If Martha Stewart was in public relations she might say, “Information – it’s a good thing.” Information can educate. It can inspire. But, it can confuse. It can even harm.

We’re exposed – sometimes bombarded – by health information everyday. It comes from our healthcare providers, from the media, from consumer groups, from government institutions and advertisements. Shirley Wang wrote in The Wall Street Journal last week, “Too much information about drug safety – disseminated through media, online alerts from consumer watchdog groups and even by the Food and Drug Administration itself – might overwhelm patients and raise undue alarm, some medical professionals caution." Indeed, also reported in this story was a survey of 300 medical professionals released last March by Pfizer that found nearly all (89 percent) were at least “somewhat concerned that patients might stop their medications if potentially negative safety information was released to the public too early."

The clutter and confusion is an issue not only for patients and caregivers but for physicians, too. The database of clinical guidelines (those standards of care developed by a wide array of medical societies) maintained by the American Medical Association contains over 2,200 entries. Some were not subjected to peer review and some contradict others outright. Dr. Darshak Sanghavi, a pediatric cardiologist at the University of Massachusetts Medical School, wrote in The New York Times recently that in the past year “the American Academy of Pediatrics abruptly reversed its recommendation that healthy infants avoid peanuts and other potential food allergens, without citing any new data. Weeks after the American Heart Association widely publicized the need to perform cardiac testing in children treated with drugs for attention problems, the academy issued a contradictory guideline discouraging such testing.”

These guidelines carry weight in determining if a drug, device or procedure will be reimbursed by insurance, and are supposed to be developed using hard clinical data – so called evidence-based medicine. But here, too, lie a bevy of contradictions. For example, Stephanie Saul wrote in The New York Times last week about the CyberKnife, an FDA approved treatment for the treatment of a variety of tumors made by Accuray. In prostate cancer, the key advantage is that treatments take five days instead of eight weeks for conventional cancer radiation. “As it turns out, Medicare pays for the treatments in 33 states — but not in 17 others. “You can live on one side of the street and get a procedure, but on the other side of the street you can’t,” said Dr. Steven D. Pearson, president of the Institute for Clinical and Economic Review.”

Where does this leave us? Here are a few thoughts:

For consumers: Trust, but verify. We’re told to rely on sources of information that we trust. But be careful. Trust is easily misplaced – just ask those who invested with Bernard Madoff. Look for information that lists its authors. Look for references. Additional comfort can be gained if the information is attached to a major medical institution, or a government agency like the NIH or CDC.

For health information providers: Release information when it’s ready, not when it’s half-baked. Many studies and interim results are made public too early. Clearly, if there’s a serious potential adverse event or public health issue, it’s important to err on the side of safety. But, in other cases, try less for a change. Not everything is news, not everything needs an announcement.

For healthcare decision-makers: Set expectations in advance for what information is needed to render judgment, while leaving room for some flexibility in a dynamic field. We need a clearer understanding of the thresholds of acceptability, when enough information is enough and transparency in the review process.

Positive steps have been taken, to be sure, but we still need to work to ensure that information is of higher quality, delivered at the right time and conveyed in language appropriate to the audience.

Go Team!

Enhancing Cohesion and Success
We work and, thus, communicate in team settings a good deal of the time. Sometimes you can choose with whom to work, sometimes you can’t. And some people would just like to be left to work alone.

I was interacting recently with five teams of randomly assigned, similarly experienced people all working on comparable tasks. Most were in the same city but in remote locations and did not normally work together. After observing some struggles, I asked each of them (about 30 people) for some feedback on how their teams were functioning and what they were doing to improve their performance. Three common themes emerged:

Some people wouldn’t do the work; they wanted a free ride.

A dictator took over the team; before we knew it, this person was delegating.

Some people would do the work if assigned but they simply would not communicate.

I think you will agree that this example isn’t particularly unusual. Some people are passive, some are aggressive and some are passive-aggressive. Baseball Hall of Famer Casey Stengel had it right when he said, “Getting good players is one thing. The harder part is getting them to play together.”

I responded to the concerns voiced by the teams with some questions: Why was it so hard to push aside individual agendas and adopt a team agenda? Did you define upfront how the team would operate? Did you discuss and agree on roles and responsibilities? Did anyone suggest a schedule or timeline? Did you discuss and agree on the best way for the group to communicate – email, IM, phone? If more than one person wanted to lead, did you consider rotating the position? Was a leader even necessary? Was time ever set aside to review and assess team performance?

After some “oh yeahs” and “we should have done thats,” we discussed the importance of finding common ground, setting expectations and keeping focus on mutual goals. Then, I made a few more queries: Why weren’t these problems ever aired? Did you try to engage the individual in question? Did anyone confront the issue?

The responses were on the order of, “I wanted to speak up about a problem person but wanted to avoid confrontation – I didn’t want to make things worse.” When I asked if there were things that held them back I heard, “Well, I was hoping someone else on the team would step up.”

We know it’s hard for most people to articulate their feelings, especially around sensitive issues. Few people go looking for a confrontation but it’s a critical part of working in teams, supervising others and being a strategic communications advisor. But it’s up to you, not someone else. And it’s not “making waves.” Making waves connotes stirring up trouble and creating new problems. This is about airing and addressing the issues by asking questions, and seeking clarifications while showing respect for different views.

We routinely seek to understand stakeholder issues and concerns when developing a message strategy or a communication plan. We need to have the same mindset when working with colleagues. Also, it helps to have at least occasional face-to-face contact. As I wrote in the December 9th post, “Face-to-face allows us to observe all the nuances and evaluate the visual cues. With these additional inputs, we’re able to assemble a more accurate picture of the particular circumstance.” And, as James Surowiecki notes in The Wisdom of Teams, “A successful face-to-face group is more than just collectively intelligent. It makes everyone work harder, think smarter, and reach better conclusions than they would have on their own.”

?-to-Face Communication

Let's Not Waste Opportunities to Make a Personal Connection

Every now and then I see an advertisement where a faceless or headless person is given the task of pitching a particular product. Some recent examples include AstraZeneca’s Symbicort (R) and HP’s personal computers.

My message to these and other companies that use this technique is to please reconsider. Do it for my benefit – I find this approach dehumanizing and off-putting. Do it for your own benefit – you’re missing the mark on building trust and empathy with your audience.

For a drug company that has done an excellent job in increasing its transparency, why communicate important medical information with a silhouette? For a PC manufacturer whose motto is “the computer is personal again,” why showcase the product with a decapitated presenter?

Perhaps the ads scored creative points with the client or tested well in a focus group. Maybe we, the viewers, are supposed to be engaged by trying to guess which celebrity is talking from a disembodied, off-camera head. Or, is it that they want us to “insert yourself here”?

I’ll admit that there are certain circumstances where this can work. Apple’s i-Pod comes to mind. But Apple has always been associated with design and creativity. There is a definite “cool” factor that’s communicated when they use those blacked-out dancing figures with the signature white ear buds bouncing and waving to popular tunes. Cachet is being built not questioned.

For the vast majority of communications using faceless or headless persons, though, how are we supposed to make a connection to the person, the product or the company? If, as Herman Melville said, “The eyes are the gateway to the soul,” then we’re being denied the opportunity to make some important judgments. How do we bond? How do we believe? How do we trust?

This isn’t just about advertisements. These are the reasons why the phone is better than email, why a video conference better than the phone, and why face-to-face communication is better than a video conference. Face-to-face allows us to observe all the nuances and evaluate the visual cues. With these additional inputs, we’re able to assemble a more accurate picture of the particular circumstance. The bottom line is that it’s the job of the communicator to provide the most appropriate pieces of information and ensure that they are received by the intended audience.

Personalized Promise

Preparing For the Era of DNA-Guided Medicine

I have been involved with the field of personalized healthcare since helping to lobby for the Human Genome Project bill in the late 1980s. In 2000, it was great to see the first “working draft” of the genome get published ahead of schedule.

Like any new technology, however, there has been a lag in translating discovery into practical application. Although DNA-guided medicine – getting the right drug to the right patient in the right amount at the right time – is not moving into mainstream medicine as quickly as we would like, we can be optimistic that it will displace traditional trial-and-error approaches with increasing speed. In addition to the ongoing efforts in the diagnostic and biopharmaceutical industries, academia and government, a new piece of legislation should spur the development and adoption of personalized medicine.

The boost may come from The Genomics and Personalized Medicine Act, first introduced in 2006 as S. 3822 by then Senator Obama and now being expanded by Representative Patrick Kennedy in H.R. 6498. The bill acknowledges that promoting the shift toward personalized medicine “will require continued Federal leadership and agency collaboration, expansion and acceleration of genomics research, a capable genomics workforce, incentives to encourage development and collection of data on the analytic and clinical validity and clinical utility of genomic tests and therapies, and improved regulation over the quality of genetic tests, direct-to-consumer advertising of genetic tests, and use of personal genomic information.”

In addition, the bill directs the Director of the Centers for Disease Control and Prevention (CDC) to “expand efforts to educate and increase awareness of the general public about genomics and its applications to improve health, prevent disease and eliminate health disparities.” Yet, it seems that these efforts might be limited to the “ongoing collection of data on the awareness, knowledge and use of genetic tests through public health surveillance systems, and analysis of the impact of such tests on population health.”

I’m afraid that what might be collected is more about what we already know – public understanding of health and science, much less genomics, is low. (Really low. Of those surveyed by the National Science Foundation, about 10 percent knew what a molecule was, about 30 percent could define DNA and about half knew that it takes the earth one year to orbit the sun!) I’d like to see the legislation strengthened by including an initiative to identify gaps in public understanding which would then lead to new efforts in public education.

Why? It’s the only way to develop and sustain trust in the new technology. Despite assurances in the Genetic Information Nondiscrimination Act of 2008, people are wary about sharing their DNA. People need know what personalized medicine can and can’t deliver. Without some greater understanding and trust in the science – and the system of collecting and processing samples – we won’t see appropriate demand, we won’t see appropriate utilization and we won’t see enough people benefiting from the information that resides in their own bodies.

Communicating Hope

Some Textbook Message Delivery

Too often we find examples of communication blunders in the news, in our offices and in our relationships. With a surfeit of “what not to dos,” it’s refreshing to discuss an example worthy of some praise.

In the last week, President-elect Obama started to fill a gaping hole in American confidence with a series of press conferences about his economic program and the team that will assist him in its implementation. The carefully crafted events have inspired hope and assurance at home and around the world. Indeed, the announcements – held over a three-day period – had a role in sparking the biggest stock market rally in past 75 years. (At this writing, however, the market is down again by triple digits.)

The messenger, the moment and the mechanics converged to provide us with some valuable lessons. So, left or right, blue or red, we should take note of excellence in communications. Here’s what I observed in the last week:

Clarity. Where we are, where we need to be and how we will get there were explained clearly and concisely with minimal jargon. Stress and pain were acknowledged but the stated goals were characterized as within reach – not dreams, not aspirations.

Authenticity. The combination of unambiguous language and sober tone created a sense of trust and calm. Although there was a “down to business” quality to the proceedings, a few quips were allowed. It served to keep it “human” and reinforced the genuine nature of the communication.

Timeliness. Critical times call for urgent action. The incoming team has moved swiftly – with “deliberate haste” – and has started to address the concerns of the public, of business and of the markets.

Momentum. Parceling out the news over a three day period created a sense of anticipation for the next installment. And, with these bites of information – one building on the next – each got its time in the sun. We were able to take the time to digest the news and understand how the pieces fit into the big picture.

Interaction. There was more to the events than the reading of a prepared statement. Questions were taken, though more orchestrated and limited than I liked. There was an interest in clarifying an issue and a willingness to defend a position.

Clearly, we’re witnessing a work in progress. It’s too early to render any final judgments. But what we saw was vision plus pragmatism. It can’t be one or the other to be successful. Vision alone is just a good intention. Pragmatism alone carries no passion around which to rally. With both, we can begin to envision a future that is achievable.