Thursday, December 17, 2009

End of Year News and Announcements

A New Book in the Works
This is my 50th entry and it’s the first one with something about me. I thoroughly enjoy commenting on news and trends, and offering up a new idea here and there. And, it’s gratifying to track how and where this is all being viewed. People from over 50 countries have visited

However, some of you have noticed that the blog articles and published pieces in the trades have appeared less frequently in the last month. I have an explanation.

A part of it is the time devoted to reading papers and grading final exams for the Research Process & Methodology course I teach at NYU’s M.S. program in Public Relations and Corporate Communications. I had another great group of students who left, I hope, as more aware users, evaluators and purchasers of research. They will help to further elevate the field, and bring a more rigorous approach to communications planning and measurement.

The other reason, I am very pleased to announce, is that most of my writing energies will be placed toward completing a book on leadership and management. Camelot, Inc. will be published by Praeger and has a planned release in late 2010/early 2011.

I will still comment occasionally here and on Twitter, be involved with NYU and be available to take on consulting assignments in corporate and marketing communications, and issues and crisis preparedness.

I wish you a happy and healthy holiday, and a wonderful year ahead. I’ll look forward to staying in touch.


Monday, November 30, 2009

Afghanistan Speech Plan

Notes for the President
Tomorrow evening, President Obama will address the nation from the US Military Academy at West Point. After three months of deliberating with his “war cabinet,” the President will outline his decision, which is presumed to include sending 30 – 35 thousand additional troops to Afghanistan. Word has been leaking for weeks (from sources including the military) about the proposed strategy, and the sides for and against it are already well developed.

We know that President Obama can deliver a great speech, but I thought I would offer up a few ideas on how to make communicate this crucial communication with maximal effectiveness. Here is what his address should contain:

The Background. It’s laudable that the President has adopted a stance of (at least attempting to) not dwell on the past. The answers are ahead of us, not behind. Yet, it’s important to explain why we are where we are. Not to be condescending, but the President should even consider using a map. Show the region, show the threats, show the opportunities. I know he’s been dinged for being “professorial,” but my view is that it’s a good thing. We have a President, a Commander-in-Chief, smart enough to give these important lessons to the public.

The Goal. Some have challenged the President to accept the military’s recommendations and move on. It’s a simplistic plea. A military strategy must support public policy goals. The question of why we are there and what we must accomplish in the name of national security must be answered first, clearly and plainly. Only after the planned outcomes have been stated can we decide on which strategies (military, diplomatic or both) are appropriate.

The Decision Process. As a corollary to the points above, it’s worth mentioning how this decision was reached. There has been criticism of the three months it has taken to debate the request for more troops. In the previous administration, many decisions came quickly, from the gut. Now, we have a more analytical, deliberative and inclusive decision making process. It needs to be explained. Moreover, the role of the military must be clarified – our civilian government should never be just a rubber stamp.

The Options. After hearing about how the information was gathered and analyzed, we should receive an overview (not the details) of the options the President had to grapple with before settling on his final decision. What were the pluses and minuses, and the potential consequences?

The Path Forward and Back. After laying out the options, make the case for the decision. What does it mean of us, for the people of Afghanistan, for the balance of power in the region? What are the consequences of increased involvement, when will we know when we’ve achieved our goals and how do we leave without causing more harm than good? And, what responsibilities will the world community shoulder? Can we count on a fairer distribution of the burden?

Acknowledge Other Worries. We all know of the disastrous experience the Russians had in Afghanistan. We know the parallels to Viet Nam are many. The President must address the concerns over another potentially bloody quagmire and how his strategy has the best chance of success. In addition, he should acknowledge the costs (human and financial), and the possible impact on the economy and on our security. He should also make the case that the seriousness of other issues – financial reform, jobs, healthcare, energy, climate change – means we must tackle our problems simultaneously, not sequentially.

Conclude with a Rallying Point. At the end, the President needs to seal the deal. That is, obtain the support of the majority of the American public. He needs to convince us that it’s time to get behind his decision and, most important, the brave men and women tasked with carrying it out. And, following the speech, surrogates from all sectors of society should be mobilized to reinforce the President’s message.

The content of the President’s speech must be spot-on but so must the tone. He must be perceived as truthful, authentic, realistic and reassuring. I’ll be tuning in at 8 o’clock tomorrow night to watch some history.


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Monday, November 16, 2009

The Pharma Pricing Dilemma

How to Rebalance the Picture
There’s front page outrage in today’s The New York Times. The pharmaceutical industry is roasted again in “Drug Makers Raise Prices in Face of Health Care Reform.” How much of the criticism is deserved, and how much is a result of poor communications or inadequate reporting?

The article cited several studies that link big increases in drug costs to legislative efforts – like bumping up carpet prices just before the big sale, or the rush to raise interest rates and fees before credit card reforms become law. The most recent study was conducted for the AARP by Stephen Schondelmeyer, a professor of pharmaceutical economics at the University of Minnesota. It concluded that drug prices increased approximately nine percent in the face of an overall decline in the Consumer Price Index of 1.3 percent. He told the Times, “When we have major legislation anticipated, we see a run-up in price increases.”

Not so, said Merck spokesman Ron Rogers. “Price adjustments for our products have no connection to health care reform.” But Joseph Newhouse, a Harvard health economist, said he found a similar pattern of stiff increases after Congress added drug benefits to Medicare in 2006. He said, “They [the industry] try to maximize their profits.”

No kidding. Of course the industry, any industry, wants to maximize their profits. Indeed, there’s an obligation to employees and shareholders. The problem is one of perception. What is smart business that helps to guarantee the long term success of the enterprise, what is abuse or greed, and what is corporate desperation?

The other side of this story is not told particularly well, and it’s hard to determine if it’s the lack of space accorded the pharmaceutical industry by the Times, the lack of a compelling message by the industry or both. The article states that “Drug makers say they have valid business reasons for the price increases” but then fails to explore it further.

Ken Johnson, senior vice president of the Pharmaceutical Research and Manufacturers of America (PhRMA), does manage to get a shot in by criticizing the study methodology and its sponsor. “In AARP’s skewed view of the world, medicines are always looked at as a cost and never seen as a savings – even though medicines often reduce unnecessary hospitalization, help avoid costly medical procedures and increase productivity through better prevention and management of chronic diseases,” he said.

Yes, good points, but readers are still left with questions and concerns. And, what about the cost of failure – the part of the price increases that are necessitated by the sheer difficulty of bringing new, differentiated medicines to the market? The reality is that, without the ability to replace innovative products lost to generic competition, outsized price increases will continue to play an outsized role in pharmaceutical profitability.

So, what needs to be done in order to achieve some balance, some greater understanding of the complexities in healthcare costs?

Provide proof. The industry must deliver concise, compelling and understandable information. Any spokesperson should be able to recite at least three pieces of evidence to support their position. And, if you believe the methodology of the offending study is flawed, develop your own bullet proof information.

Utilize credible supporters. The extreme pricing contention was delivered by two academics, a consumer group and an industry analyst. The industry’s position was staked out by the pharmaceutical trade association. It’s clear where most readers will place their trust.

Strike the right tone. Lashing out may be tempting but it could have the effect of creating sympathy for your adversary. And, in this case, the object of PhRMA’s annoyance – the AARP – represents millions of the industry’s customers.

Think about the timing. It may be that, as Catherine Arnold of Credit Suisse said, “If you’re going to take price increases, here and now might be the place to do that, because the next year and the year after that might be tough.” But, if these price increases cancel out some of the savings promised by the industry during negotiations over health insurance reform, don’t be surprised if some legislators attempt to exact new concessions with renewed determination.
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Friday, November 6, 2009

The Twitter Tail Wagging the Corporate Dog

This article also appears in

Social Media Are the Means, Not the EndsWhile scanning through a long list of Twitter posts the other day, I saw a link to TechCrunch, a blog “dedicated to obsessively profiling and reviewing new Internet products and companies.” An entry by MG Siegler, “Comcast: Twitter Has Changed The Culture Of Our Company,” caught my attention.

Sure, technology can help drive cultural change. Think of the tools of war over the centuries or what the automobile has meant to society. The examples are endless. But the culture of a company?

Yes, according to Comcast CEO Brian Roberts. In response to a question about the role Twitter was playing with the cable communications giant at the Web 2.0 Summit in San Francisco, he said “It has changed the culture of our company.” He backed that up by saying that Comcast uses Twitter to scan for complaints and engage with customers.

OK, maybe Mr. Roberts got caught up in the moment. After all, he was at a social media conference. And, it’s great that Comcast is using new tools (Facebook and other networks were mentioned) to address issues around customer service. However, this does not a culture make.

Tools support the strategy (and, thus, the objective), not the other way around. The tools of war support the policies of government. The automobile supports our mobility. You get the idea. Comcast delivers communications products and services. Its culture should be wrapped up in service delivery and excellence whether Twitter exists or not.

So, if Twitter really did change the culture at Comcast – all of a sudden becoming a company focused on customers and what they want – I wouldn’t be crowing about it. I’m guessing, but what may have happened was that seeing thousands of Twitter-fueled complaints was Comcast’s wake-up call. Twitter makes it easy to sound-off – much easier than having to find a telephone number to call, listen to the prompts, press 1, listen to some more prompts, press 4, and so on. Seeing this groundswell may have acted like a cyber-mirror and forced them to look at themselves, and reflect on who their customers are and how they conduct their business.

Web 2.0 offers us wonderful tools. We’re nowhere near realizing their potential or knowing how they will evolve. What should be known (and written in stone), though, is what our companies, institutions or organizations stand for. The decision to adopt a particular technology should only be made if it helps us achieve that end.

Between blog posts, you can follow me on Twitter.

Tuesday, October 27, 2009

American Cancer Society vs. The New York Times

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Feud Adds to Public Confusion Over Cancer Screening
As if there isn’t already enough conflicting information about cancer screening, a tiff between The New York Times and the American Cancer Society – two trusted sources of information – have the public scratching its collective head. It’s another example of how the current state-of-the-art in diagnostics, conflicting medical points of view, and the way in which healthcare news is communicated can cause people to either run to or away from their physician.

Veteran healthcare reporter Gina Kolata reported that the ACS “is quietly working on a message, to put on its Web site early next year, to emphasize that screening for breast and prostate cancer and certain other cancers can come with a real risk of overtreating many small cancers while missing cancers that are deadly.” Dr. Len Lichtenfeld, Deputy Chief Medical Officer of the ACS, writing in his blog, counters that it’s not true. He wrote, “The American Cancer Society is not working on any stealth project to change commentary on our website to emphasize the shortcomings and risks of screening.”

With a tone of exasperation, Dr. Lichtenfeld went on to write, “And here is another news bulletin for the press and the rest of the media: developing and accurately promoting guidelines are complex processes that don’t lend themselves to sound bite messaging.” So true. Cancer is incredibly complex and the screening tools are far from perfect. Yet, it was Dr. Lichtenfeld’s boss, Dr. Otis Brawley, who was quoted in the Times article. He said, “We don’t want people to panic, but I’m admitting that American medicine has overpromised when it comes to screening. The advantages of screening have been exaggerated.”

What’s really going on here?

1. We have a gender gap. Much of the controversy boils down to the fact that prostate screening is less effective than breast cancer screening. It’s a message not very many men want to hear.

2. Cancer diagnostics are not created equally. In addition to some screening tests having greater predictive powers than others, they do not differentiate between tumor types that may be more or less aggressive. This has a big impact on which cancers to treat or just to observe.

3. The ACS needs to harmonize its message. A third ACS executive, CEO Dr. John Seffrin, has now weighed in on this story. He said, “we have long acknowledged that cancer screening isn’t perfect. Sometimes cancers get overlooked. Sometimes cancers get misdiagnosed. Sometimes aggressive cancers can appear even after a clear screening test. It is important to acknowledge these limitations, understand them, discuss them with your doctor, and decide what is right for you.”

4. Physicians need to find the right language. The pros and cons, the risks and benefits, if and when to treat – they all must be discussed. It takes time, and it takes some skill to understand their patient and their ability to understand and deal with the facts.

5. The public needs improved health literacy. A corollary to number 4 above is that the public simply does not have a good enough grasp of the scientific concepts or the ability to assess the risks or benefits. If The New York Times and the American Cancer Society can’t agree or somehow misunderstand each other, then what hope should the average citizen have of making heads or tails of all the possible screening and treatment options?

Let’s hope we can get back on the same page and deliver timely, accurate and understandable information on what is literally life and death information.

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Monday, October 19, 2009

A Healthcare Answer For Some But Not All

The Internet Is Another Health Disparity That Must Be Addressed If you ask your friends, relatives and colleagues if they’ve used the Internet to find healthcare information, I’d be willing to bet the answer would be yes. There’s no question that the Internet is an ever more important healthcare tool. The ability to capture and consolidate information into electronic medical records; search and share health and wellness resources, and enhance communications between professionals and patients are among the many benefits of the web. It’s OK to cheer but just not too loudly.

The problem is that our friends, relatives and colleagues aren’t everyone – not by a long shot. According to Neilsen Online, there’s a whopping 277,636,000 Internet users in the U.S. The flip side of this seemingly good news is that it leaves about 30 million Americans disconnected from the world wide web and, thus, unable to access important healthcare tools and information.

The web is no panacea, of course. You may have read some of my previous articles where I pointed out the problems of web-based healthcare information. Because there’s so much junk science reported and repeated in cyberspace, it can be a case of information doing more harm than good. Still, there’s a growing list of important applications that will not be available to all who could benefit from them.

Take Keas, for example, the new company that boasts Google Health and Microsoft HealthVault as partners. Keas seeks to marry personal data and health information to produce personalized health plans for individuals. Delivered right to your desktop or smart phone might be diet and exercise advice, an explanation of lab results, different treatment options or reminders to take a medication.

During the healthcare reform debates, we heard repeatedly that a key to lowering costs is to have a healthier nation and that this goal will only be possible if individuals take more responsibility for their health. While we could achieve a lot if plain old common sense was applied more often, tools like those being developed by Keas could play an important role in both learning about and managing one’s health.

If experts are telling us that things like electronic medical records, on-line health information and personalized health plans are important to healthcare reform efforts and our own personal well being then we need to be thinking about two kinds of health disparities: insurance coverage and Internet access. Creative, cost-effective ways to distribute computers and expand broadband access must take on new urgency. The benefits would be manifold.

And, access should include more than the ability to go on-line. Access is meaningless if one can’t interpret what one has found. Even for those with Internet connections, there’s an enormous deficit in health literacy that threatens the public health, such as sensationalized claims that lead people to take potentially dangerous alternative medicines or parents to refuse vaccinations for their children other than for legitimate medical reasons. If there’s any hope in increasing coverage and quality while containing (or even lowering) costs, more attention must be placed on expanding access to and understanding of healthcare information.

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Friday, October 9, 2009

Informed Dissent

H1N1 Vaccine is Here With Too Few Takers
Parents want the best for their children – happiness, success and good health. But nearly two-thirds plan on delaying or denying vaccinations against the H1N1 flu to their kids. It’s more than ironic to me, especially when so many complain about the lack of access to preventative care in this country.

Two similar polls just came out – one from the Associated Press-GfK and the other from Consumer Reports – that demonstrate that only about half of the U.S. population will be vaccinated. It’s not big news, though. This sort of result has been the unfortunate norm.

Why haven’t the numbers improved? Why are people so wary? Why are there so many who actively oppose vaccination? Is this just a case of people not being adequately informed? And, is this the government’s fault? The report published by the AP said that “The survey raises questions about government efforts to stem illnesses already spreading widely across the country.” I’m not quite sure what this statement is based on but my view is that the public-private partnership that has made millions of doses available is an impressive achievement.

So, allow me to briefly address some of the suspicions and concerns:

Flu isn’t all that serious. Influenza and pneumonia are the eighth leading cause of death in the U.S. (over 56 thousand annually).

It may be safe but I worry about side effects. Everything we do carries a risk. One must weigh the risk of injection site swelling and pain against contracting the flu with its potentially serious sequelae.

The vaccine hasn’t been adequately tested. Again, nothing is fool-proof, nothing is risk-free. FDA’s requirements for safety and effectiveness, however, are demanding. Moreover, the methodology for manufacturing the H1N1 vaccine is no different from other flu vaccines – vaccines that have an excellent safety record.

Vaccines can cause autism and other diseases. We may never know with 100 percent certainty but every credible study and review thus far (the most recent having been conducted by the Institute of Medicine) has concluded that there is no causative link.

I don’t think I/my children will get the flu. Sure, you might get lucky but why count on this wishful thinking? It has already been reported in 37 states – a much more rapid spread than in previous years.

I don’t trust it if the government is behind it. Fine, have a healthy skepticism but please don’t take it too far. Don’t undermine your health or the health of your family by listening to the fringe opinions of people like Rush Limbaugh who recently said that “All of this is designed to get people to respond to government orders, not to do things or to do things. It is designed to expand the role and power of governments and schools, and the media, of course, just falls right in line here with amplifying the nature of the crisis.” It's too bad there's no vaccine for paranoia.

If there are such good responses to these concerns, why aren’t people listening? Why aren’t people better informed?

My sense is that people are listening. They listen to and are informed by people that make sense to them. The CDC and NIAID have been all over the news with compelling information. About half of the country will act on what they heard. The other half will not be convinced. The message from anyone employed by or connected to these sources will not be trusted.

This is a barrier that will probably take a long time to breach. The ongoing outreach and education must continue while new efforts must be established to address the reasons why health messages bounce off of so many. Politics and conspiracy theories aside, elevating the public’s health and science literacy may give everyone a common ground from which to make their healthcare choices.
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Wednesday, September 30, 2009

1776 Déjà Vu?

So Much Hinges On So Few
One of my children was just watching the movie version of 1776, the musical show about the events leading up to and including the signing of the Declaration of Independence. In the Broadway account, the fate of the document, the fate of the world, came down to James Wilson of Pennsylvania. Pennsylvania was, indeed, torn between reconciliation and war with England. In a last gasp appeal, John Adams spoke out. "It would be a pity for a man who has handed down hundreds of wise decisions from the bench to be remembered only for the one unwise decision he made in Congress." Wilson (who, in reality, spoke forcefully for independence) relented. He didn't want the attention or the responsibility. "Mr. Adams is correct about one thing," he said. "If I vote with you [John Dickinson], I'll be the one who prevented American independence."

Healthcare reform and the signing of the Declaration of Independence may not be in the same league of American milestones, but the parallel struck me. Of course, there have been many, many instances where critical decisions came down to one unsuspecting or unprepared (or manipulative) person. But here we are. With the so-called public option going down to defeat in the Senate Finance Committee, it is now highly unlikely that any subsequent amendments with such a provision will survive.

And what does that mean? The table is set for Senator Olympia Snowe to play James Wilson. Sixty votes will be needed for passage and it's looking more and more like achieving meaningful (though highly compromised and far from perfect) healthcare reform any time in the foreseeable future will rest with the capable centrist from Maine.

The optics aren't pretty -- the old saying about laws being like sausages comes to mind. And what got us to this point hasn't been any more attractive. The raucous Town Hall meetings over the summer -- the shouting down of elected officials and the perpetuation of false claims -- did not instill confidence in the process of creating legislation. Politicians need to pay more attention to this point. The substance is important but, when it comes to building trust and unity, the visuals and the tone mean a great deal, too.

While one voice may decide the fate of healthcare reform, it's interesting to note which voices went largely unheard. The most vocal weren't those with the most to gain -- the roughly 46 million without insurance. The squeakiest wheels were found on those who believed that reform will diminish their care or cost them more money. They had the best access to the media, the best messaging consultants. So much for Life, Liberty and the Pursuit of Happiness for the rest.

Yet, some major groups that were lined up against previous reform efforts -- most notably the pharmaceutical industry and organized medicine -- are now advertising their support. Despite the bad press over the haranguing and arguing, there has been much more engagement, much more deal making and number crunching. Making a business case, not just an emotional one, may be the winning formula this time around.
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Wednesday, September 16, 2009

Chill Pills All Around, Please

Outbursts and Meltdowns Punctuate the Week
Civility was in particularly short supply this past week. Representative Joe Wilson of South Carolina shattered precedent and decorum by yelling “You Lie!” at President Obama during a joint session of Congress. Tennis star Serena Williams threatened a line judge at the U.S. Open with bodily harm following a blown call. Rapper Kanye West grabbed the microphone away from Taylor Swift, trampling what was to be her acceptance speech at the Video Music Awards, to disagree loudly with the judges’ choice. Conservative “Tea Party” events protesting big government saw slogans that included "Unarmed, this time," "Impeach the Muslim Marxist" and "Obama is trying to kill my mama."

It seems that these types of breakdowns in behavior (and good sense) are becoming more strident and are occurring more often. Why?

There is often little, if any, consequence. One reason that we have so much boorish behavior and repeat offenders is that people get away with it. Most people and organizations aren’t willing to set limits. There are too few that will object when “the line” has been crossed.

You can chalk it up to emotion. We’ve heard them all this week: “I’m a very passionate person,” “It was just a spontaneous outburst,” “My emotions took over.” Sorry folks. These are tired and wholly inadequate excuses.

People can blame the “fringe.” Another convenient excuse is to say that the particular incident wasn’t sanctioned. “We can’t be held responsible for the actions of individuals” goes the refrain. Fine. But did anyone speak out? Did anyone say you’re at our event and you’re out of line?

There are some important bottom line considerations in all of this:

Behavior still counts, at least for some. Unless you want to be known as a beast, you are harming your personal brand – or the brand of your organization – by engaging in uncivilized behavior. We all know that part of successful reputation management is setting the proper tone for communication.

Examples are being set. Like it or not, these high profile offenders have fans, they have constituents. They’re role models. Without any impediments, these behaviors are bound to be emulated and propagated.

Bad behavior can incite worse. With each unchecked incident, the line separating good behavior from bad gets shifted. A new, potentially dangerous norm is set. In the most extreme case, it seems that the threshold from outburst to threat or from threat to violence is getting unsettlingly easy to breach.

Manners can trump message. At the core, though, it’s the message – the actual facts of the matter – that get lost. Are we talking about the tennis play between Williams and Clijsters? Swift’s music video? In the case of politics, we’re pulled away from an actual, healthy debate and forced to discuss the spectacle. Moreover, the public is often asked to take a side. The “if you’re not with us you’re against us” mentality still runs deep in enough of the population to threaten compromise or legitimate disagreement. This helps to crush the middle ground and polarize opinion further.

I hope the shrillness and the intolerance can be mitigated. It’s not like this is a new problem, either. It’s been discussed for millennia. Remember “Love thy neighbor as yourself” (the ethic of reciprocity)? It’s time to deliver.

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Thursday, September 10, 2009

A Military Man Points the Way, Again, On Strategic Communication

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An Admiral Sets a New Course
Carl von Clausewitz, the 19th century Prussian general, may not be a household name but he laid the groundwork for the way in which the modern military thinks and plans strategically. In 2001, the Boston Consulting Group condensed and rearranged his voluminous writings into a neat little book (Clausewitz on Strategy: Inspiration and Insight From a Master Strategist) that provided some important lessons for the battlefields of the business world.

Indeed, many of Clausewitz’s observations translate quite well to the issues surrounding successful communication: defining objectives, understanding the audience and their agenda, adapting to changing conditions, clear accountability and communication channels, and, ultimately, changing a behavior.

In the case of executing U.S. foreign policy, however, something has been lost. In his recent “From the Chairman” column in the Joint Force Quarterly, Admiral Mike Mullen, Chairman of the Joint Chiefs of Staff, warns that we’ve “walked away from the original intent” of strategic communication by allowing it “to become a thing instead of a process, an abstract thought instead of a way of thinking.”

Admiral Mullen reminds us of some important truisms not only for the successful execution of policy but for communicators everywhere:

Understanding. We need to start with research and data gathering. The key, of course, is turning the information into insights that will help guide the strategic initiative. What is it that our audience believes? What should be said and done to influence them? What might be our common ground?

Listening. Gaining a greater understanding of the issues and concerns, and building trusting relationships are endeavors with a component of mutuality. “Good communication runs both ways. It’s not about telling our story. We must also be good listeners.”

Relationship Building. It takes time. It’s an investment. “Our messages lack credibility because we haven’t invested enough in building trust and relationships, and we haven’t always delivered on promises.”

Trust and Credibility. The issue above speaks loudly also to follow through and perseverance. “We hurt ourselves more when our words don’t align with our actions.” And what we say and do cannot be just for show; they cannot be delivered expediently. “We’ve come to believe that messages are something we can launch downrange like a rocket, something we can fire for effect. They are not.”

Accountability and Ethics. Behavior is important. Ethics cannot be optional; they cannot be episodic. “We must be vigilant about holding ourselves accountable to higher standards of conduct and closing any gaps, real or perceived, between what we say about ourselves and what we do to back it up.”

Tone. It’s not just the substance that’s important; the way in which we communicate has a lasting impression. An unambiguous message that is encased in civility and mutual respect is the best case. “I hope we learn to be more humble...”

Admiral Mullen deserves a salute from us civilians for elevating the discussion on strategic communication, and highlighting the importance of how we go about shifting perceptions in the attempt to elicit behavior change. Now, more than ever, we should take heed of the lessons inspired by Clausewitz who, as expressed in the BCG book, offered "new ways to order thinking in disorderly times" and provided a "steadiness in charting strategy in an unstable environment."
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Friday, August 28, 2009

Moving the Needle on Clinical Trial Recruitment

Poor Communication is Among the Obstacles to Research
The passing of Senator Ted Kennedy has come to dramatize many things, like the importance of representing all stata of society and the need for new voices of compromise in the Congress. And, the necessity of further advancements in cancer therapeutics.

Senator Kennedy died of glioblastoma, one of those cancers that goes tragically hand-in-hand with “death sentence.” He had the best care available but, obviously, it wasn’t nearly good enough. There have been advancements, of course. Survival for this particular form of cancer has improved from about four months to about 15 since President Nixon’s famous 1971 declaration of a “war” on cancer.

The change has been incremental. A big obstacle to the discovery of truly breakthrough medicines has been the maddeningly complex nature of the disease. There is hope, however, that our ever-increasing understanding the molecular biology of tumors will lead to new interventions.

But that brings us to another big obstacle. When new, experimental therapeutics are available, they must be tested in clinical trials to ensure that they meet agreed upon standards of safety and effectiveness in people. The problem is that there is a chronic shortage of patient volunteers. Currently, there are more than 6,500 cancer clinical trials available (most trying to fine-tune cocktails of existing drugs) yet only three percent of adult patients agree to participate. In a recent article in The New York Times (“Lack of Study Volunteers Hobbles Cancer Fight”), Gina Kolata reported that “more than one trial in five sponsored by the National Cancer Institute failed to enroll a single subject, and only half reached the minimum needed for a meaningful result.”

The article cited a number of reasons for this low participation rate, among them: oncologists not wanting to refer patients away from their practices, reimbursement headaches, record-keeping and staff requirements and patients wanting to avoid any additional hassles.

Then, there’s fear. Even with Institutional Review Boards checking the ethics of study protocols and crafting of extensive Informed Consent documents, patients worry about being guinea pigs. They worry about getting a placebo instead of the active agent, even though the vast majority of studies only use the current standard of care and the investigational product. For some, tragedies of the past are proof of what can go wrong. The Tuskegee study (looking at the long-term effects of untreated syphilis in African-American men) and the Atomic Energy Commission study (that gave pregnant women radioactive iron but were told it was a “vitamin cocktail”) continued into the 1970s. That’s recent history for some of us.

Another barrier to patient recruitment is just a plain lack of information – most patients (and many physicians) are unaware of the existence of clinical trials that might be appropriate for them. It has been reported that 85 percent patients and 31 percent of physicians lack sufficient information about available studies. For those who were aware of trials, the top reason for refusing to participate was concern over their privacy and confidentiality (according to the Institute of Medicine).

Professional and patient advocacy organizations, the National Institutes of Health, hospitals and biopharmaceutical companies all promote clinical trials in some form or another, and try to communicate privacy safeguards. Now, Pfizer is taking a new step to address these impediments to research progress. They announced a partnership with Private Access to allow patients to “be more quickly and precisely matched to appropriate clinical trials while simultaneously protecting their confidential personal health information.” This on-line platform is planned for introduction late this year.

This could be an important, innovative step but perhaps a small one. A Harris Interactive survey in 2007 showed that the public’s confidence that their health records will be kept confidential is already fairly high. Seventy percent of respondents agreed that they are “generally satisfied with how their personal health information is handled with regards to privacy protections and security.”

So, where are the gaps? What else can be done to help convince patients to participate in clinical trials?

1. Clearly, we must keep communicating and educating – keep pushing the rock up the hill. The word must continue to get out with information targeted to the audience.

2. The process must be made as simple as possible – simple to understand for the patients and simple to administer for the study coordinators. And, some of the trials and their reporting requirements must be simplified. Not slackened – simplified. I have consulted on a number of patient recruitment projects and, after reviewing the protocol, and surveying the investigators, study nurses and the study population, have told the sponsors on a number of occasions that their study is just too complicated, just too onerous. First, sharpen the objectives and focus on what is truly important. Then, find ways to cut down on the number of office visits, the number of needle sticks, whatever.

3. The “what’s in it for me” question must also be addressed for all the parties involved. What would it take to get more physicians to refer their patients? What changes to reimbursement need to be made? What can be said to patients and their families so that they better understand their contribution, and feel more connected to the study and its outcome? What new incentives can be created to ensure that investigators don’t just sign on to the protocol but actively recruit study volunteers?

We can’t expect to achieve all that we want by attempting to address just one piece of the patient recruitment puzzle. We need to look at these issues – including privacy – together to really move the needle.
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Friday, August 21, 2009

TV News is Taking Viewer Opinion to the Extreme

This article also appears in

Sloppy Journalism Can Distort Public Sentiment
I have spoken out about the decline of journalism a number of times. Staff and budgets are shrinking, and the ability of the public to receive well researched news and information is suffering. How are news organizations coping?

One way has been to update and elevate the “man-on-the-street” interview. Used typically to gather some quick reactions from “average” citizens, television news has been devoting an increasing amount of air time to these spots at the expense of real reporting.

With an Internet connection, anyone can become an information source. And anyone can call him or herself a journalist. Some have heralded the arrival of the “citizen journalist” and the gigabytes of “consumer-generated content” as a way to fill the void. I am not one of them. As I’ve said before, citizen journalism is not journalism.

But that opinion doesn’t seem to be shared by television news. They are all eager to receive your emails, YouTube videos, “tweets” and Facebook postings in reaction to the issues of the day. In return, you will get your message posted and maybe even shown or read on the air.

I acknowledge that news and entertainment was converging before this big downturn in the business of journalism, and that this a clever way to engage the audience. Reaching out and obtaining feedback is smart. All businesses need to connect to their stakeholders. But you wouldn’t find a business pulling random customers off the street and putting them on the factory floor or on the phones.

Beyond this being a cheap and easy way to fill some time during a 24-hour day, there’s a more insidious element. Who chooses which comments to air? How are respondents vetted, if at all? Is a balance of opinion sought and, if so, how is it defned? Do the aired responses in any way reflect actual national, regional or local opinion? Does anyone understand how easily bias can be introduced to the news?

My fear is that expediency and a tilt toward showcasing intentionally provocative responses gives a warped portrayal of public opinion. More than just cutting corners or differentiating their broadcasts, this sloppy journalism can give the appearance of an actual poll. I’m all for sharing comments, and exchanging views and information but a more rigorous approach toward 21st century man-on-the-street interviews must be taken to ensure interesting but accurate reporting.
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Thursday, August 13, 2009

Homework for America

Read First, Debate Healthcare Reform Second
Healthcare reform has been discussed since Teddy Roosevelt’s time. We’ve made improvements throughout the years, of course. But they’ve always come with a struggle. The issues and arguments we hear today – excessive cost, loss of choice, the proper role of government – are not new. So, should the Democrats be surprised that some angry people are showing up at their Town Hall meetings?

Probably not. The trend had already been set. Unfortunately, though, we’ve seen an escalation in anger and a decrease in civility at public events over the years. What promised to be a vigorous negotiation over the latest round of healthcare reform proposals has turned into some ugly confrontations. True, America is all about standing up for ones beliefs and having the freedom to do so in public. What we have seen, however, is not a respectful give and take. There’s not nearly enough discourse and debate, and there’s entirely too much ranting and raving. The bottom line is that there’s precious little communicating going on.

Indeed, debate is about putting forth a proposition and allowing a rebuttal. Instead, healthcare reform is being hijacked by a loud minority of citizens who have no actual interest in participating in a productive conversation. For them, it’s not a question of finding a solution, thrashing out a compromise on problematic provisions, or discussing to what extent the government should play a role. It’s about no government. Rather than becoming a rallying point for a common good, healthcare reform has become yet another “wedge issue” like abortion, school prayer or creationism. It’s another example of the polarization of America , the land of the disappearing middle ground, where threats and intimidation can displace rational thought. Agreeing to disagree is becoming less of an option.

When challenged, when asked to stop the heckling, the healthcare reform protesters exclaim “This is America. It’s my Constitutional right!” And, they’re right… to a point. It’s not alright to inhibit the speech of others. We should want debate. We should want to exchange views. We should want the facts. We should want to communicate.

Invoking the Constitution is interesting, though. I’m wondering just how many Americans have actually read it. The protesters should remember that some of its first words are to “form a more perfect union” and to “promote the general welfare.”

So here’s the homework assignment America: read the Constitution. Know what you’re talking about when you use it to defend your rights. And, while you’re at it, read a few good biographies of the “founding fathers.” See for yourselves what their intentions were in creating our United States.

A special homework assignment is given to all of the politicians and political pundits out there. Read the healthcare reform proposals for yourselves before you talk about the potential pluses and minuses. This is for the public good as well as your own (unless you want to be embarrassed by a poor grasp of the facts). For example, over the past few weeks there have been repeated warnings about government “death panels” that will decide who lives and who dies. On former Senator Fred Thompson’s radio show, former New York Lieutenant Governor Elizabeth McCaughey said, “Congress would make it mandatory – absolutely require – that every five years, people in Medicare have a required counseling session that will tell them how to end their life sooner, how to decline nutrition, how to decline being hydrated, how to go into hospice care.” awarded her its “pants on fire” rating for its complete lack of truth. And former Speaker of the House Newt Gingrich was corrected twice by “This Week” host George Stephanopoulis this past Sunday. Mr. Gingrich waved him off and implied that something along those lines were buried somewhere in the 1000+ page proposal. (Again, it’s not.)

I’m hopeful the situation will improve. I saw a good sign at the President’s Town Hall in New Hampshire on Tuesday. The huge crowd was well behaved. Views were expressed, questions were asked and responses were returned. Why the difference? Perhaps people were more deferential toward the President than they were toward members of Congress. Perhaps it was the heavy presence of Secret Service agents. Or, perhaps it was because the attendees were a true cross section of America. Unlike the Town Hall meetings held by members of Congress, people were admitted to the Presidential Town Hall by a lottery – they were randomly selected. Thus, it was impossible to stack the deck with partisans and troublemakers. Whatever the reason(s), let’s continue to communicate knowledgeably, passionately and respectfully.
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Thursday, July 30, 2009

Observations on the Social Media Landscape

This article also appears in

Web 2.0 is Like Being at Square 2.0
We can see some of the benefits of new media every day. Companies, associations and organizations are reaching out to engage, educate and sell to their publics. Information is finding new ways to bore through the firewalls of intolerant regimes. The lonely and the shut-ins have virtual life lines to the outside world. People are reconnecting, catching up and sharing news.

I’ve had some good experiences with new media, reaching "influencers" and gaining news placements. On the personal side, it’s been nice to reconnect with old friends and colleagues. Not long ago, I received a LinkedIn invitation from a friend who was in Cub Scout Pack 92 with me back in the fourth grade. Twitter is a different story, though. I'm still churning through sites in the hope that they can give me at least a 10 percent chance of reading something of actual interest.

That aside, it’s exciting to see new ideas and experimentation taking place. Yet, with the deluge of offers I receive for webinars, courses and books, you would think the self-proclaimed gurus have Web 2.0 all figured out. Every time I turn around, my e-mail in box fills with “must attend” events like Social Media Crash Course, New Media Boot Camp, Social Media and New Media Boot Camp, New Media PR Master Class, Writing for Social Media, Social Media Best Practices, Social Media PR Power Guide, Social Media for Disaster Response and Recovery, and Social Media Strategies. (Note to gurus: it is not a strategy – it’s a tactic.)

While there are people who have better technical skills and know more than others about these media, we’re a long way from fully grasping its potential and its potential consequences. Along the evolutionary continuum of social media, we’ve just left knuckle walking to stand upright. Like the Neanderthals, we’re bound to see lots of offshoots that dead end into oblivion.

Oblivion is where many in and around the media business say newspapers (and books and magazines) are headed. They may be right… eventually. I do read a lot of material electronically but I don’t want to give up the ability to turn the page of my hard copy. (I take some comfort knowing that the crystal ball keepers who manage the Star Trek franchise have, on several occasions, made books the perfect gift in the 23rd and 24th centuries.) Indeed, when it comes to media consumption (according to Ketchum’s Media Myths & Realities Survey, 2008), social networking sites, blogs, videocasts and podcasts combined don’t come close to local newspapers (or network or local or cable TV news).

As social and electronic media gain ground, however, it seems to be pushing other forms of communication to the rear. A growing number of people -- practically everyone I know in generations Y and Z -- will use Facebook, AIM or send a text message before they’d ever make a telephone call. This leads me to question the actual use of the term “social” in social media. Certainly, it’s safer to write a message than to use one’s voice. Words can be chosen and rewritten before sending. Direct confrontation is avoided. But this is the opposite of social interaction. It’s remote, it’s disembodied. From the Random House dictionary (the 10 pounder on my bookshelf), social “pertains to, devoted to, or characterized by friendly companionship or relations.” Merriam-Webster (on-line) defines social as “marked by or passed in pleasant companionship with one's friends or associates.”

Like friends, music and art, a mix of the old and the new can make the picture complete.
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Monday, July 20, 2009

A Message to Reach the Stars

Communicating Our Way to Space
Forty years ago today. I can remember that evening so clearly, sitting at the edge of my parent's bed to get the best view of the TV as Neil Armstrong descended the ladder of the Lunar Excursion Module. Then, with Walter Cronkite's narration, we all witnessed the triumph of the first step on the moon. No VCRs or DVRs, kids. My father put his Bolex camera on a tripod and took 16mm movies of the television tube.

I'm sorry that Cronkite won't see this or any other anniversary of the moon landing. The legendary/iconic/most trusted/uncle-to-all news man will be missed. For other fans of the space program, when it comes to walking on the surface of other worlds, all we'll have is anniversaries for a while.

For the surviving septa and octogenarians who were part of those groundbreaking Mercury, Gemini and Apollo missions, this is another milestone to lament the long absence of people breaking away from earth orbit. There have been some tremendous milestones in space, of course -- weather and communications satellites, the International Space Station, space telescopes and other astronomical instruments, deep space probes, the Martian rovers. But robotic tracks on Mars are no substitute for human footprints.

What first put us into space, however, was far from these lofty visions. It was the Cold War and the strategic "missile gap" with the USSR. In an opinion piece in Saturday's The New York Times (One Giant Leap to Nowhere), Tom Wolfe wrote that we were successful in winning the space race because we had a clear purpose, a clear rallying cry, a clear message.

He may have a point. We've gone from regaining a military advantage and saving the "American way of life" to... what exactly? We've heard a number messages from NASA, its contractors, space enthusiasts and Congress, including: we need to ensure our global competitiveness, we must continue to map and explore the heavens, some science can be conducted only outside of our atmosphere, it's a moral imperative for the U.S to lead in space, it will sustain thousands of skilled jobs, it will spawn new businesses and products, we need new inspiration to drive us forward and revive our spirit.

Wolfe said that "What NASA needs is the power of the Word" and a "philosopher" to help articulate the rationale for an ongoing commitment to space. The one and only, he said, was Werner von Braun but "NASA couldn’t present as its spokesman and great philosopher a former high-ranking member of the Nazi Wehrmacht with a heavy German accent." The message von Braun wanted to convey was that we need to find a way to get off the planet -- all of us. He knew that, in its death throws (a few billion years from now), our star will expand and envelope Earth. We would have to get away one day, and not just to potentially habitable Mars. We would have to leave the solar system.

The survival of humanity. This is clearly the most important message one could ever hear but also the least urgent. Maybe in the year 100,002,009 Congress will start appropriating some funds with a few hundred million years to spare! Of course, we might want to act faster. Von Braun, as far as I know, didn't mention the possibility of nuclear war, a collision with an asteroid or comet, or the impact of unchecked climate change.

We need more than messages, of course. Any communicator knows that a message requires proof points -- evidence to support the statement. They must have relevance and be compelling, and instill support if not positive action. They must be coherent, and in a language the public and other stakeholders can understand. And, they must have immediacy. The question of why now must be answered.

Whatever the message and whoever the spokesperson, I hope we get back on a trajectory to the stars.
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Thursday, July 16, 2009

What's in a Name?

A Story of Discrimination
The Senate hearings for Associate Justice-designate Sonia Sotomayor have been full of talk about discrimination -- her "wise Latina" comment and the case involving white New Haven firefighters, for example. It reminded me about a piece I wrote on gender discrimination several years back but never published. I'm sharing it with you now:

I can remember when, a few years ago, an acquaintance heard that my wife and I were expecting a baby girl. It was information I was delighted to have circulated but I learned quickly that he didn’t see the news in the same light. “You must be disappointed,” he said. I felt a viceral jolt with those four words. I couldn’t believe what just came out of his mouth and into my ears. So, I asked him to repeat it. He attempted to clarify by saying, “You know, with this one you’ll have four daughters. Are you OK with it?”

Yes, my wife and I have four kids -- one shy of an all female basketball team. (No, we don't plan to fill the Center position.) Each of my children have their own unique gifts but share savvy, humor and compassion. I get comments all the time about their beauty and good manners. Unfortunately, people also feel quite uninhibited in sharing and spreading their prejudice.

Whether on a city street or a suburban sidewalk, in an airplane, at a mall, in a museum or while eating at a restaurant, people have felt free to approach me and my children (yes, with the kids surrounding me) and ask, “Are you still trying for the boy?” or “Did you get someone upstairs angry at you? Ha, ha!” Someone at an elementary school event asked, “Do you feel less of a man, not having a son to pass things down to?” Even some not-to-be-named relatives wondered out loud "How can you handle all of those girls?”

Years ago, as a younger father not wanting to offend anyone, I laughed off the insults by chuckling an inoffensive reply about how lucky I was to have such a wonderful family. Over the years, though, my standard retort got less tolerant and more admonishing. “I wouldn’t have it any other way.” “What century are you living in?" "We’ve taught our daughters that they can learn, do and accomplish anything.” “I can tell you honestly that I never hoped for a boy… just a healthy human!”

I can't answer why strangers feel compelled to offer up their misguided attempts at conversation and social commentary, but there’s a larger issue here. People don’t think about how their words can hurt children – and not just the girls. There’s a clear message being sent to the boys, too. These are exactly the kind of ignorant, damaging messages that support an environment of ongoing discrimination and bias. On a different scale, societal or religious indifference to – or acceptance of – unequal gender valuation has translated into female infanticide and genital mutilation.

When I read that an Egyptian father stabbed his seven children, murdering four, because he had no sons, my heart sank and my blood boiled. Where do we start? How do we get people to gain some insight and change behavior? In the schools? When one of my daughters was asked to draw a scientist, she was the only one in the class who thought to draw a female. In the entertainment media? Not with reality shows and shock jocks objectifying women. At the doctor’s office? When another daughter -- about eight years old at the time -- was being examined by a pediatrician, he said to her that “your daddy told me he wanted four boys instead.” She responded confidently, "No he didn't." We never went back.

For any chance at breaking the cycle, the best first course, I believe, is to start at home. Home needs to be a safe harbor. It must be a place where our children can expect best behaviors from us. We need to be more active commentators about discrimination, and strategize with our kids on how to advocate for themselves and others.

Home for one person, though, was where he received a badge of discrimination to wear for the rest of his life. I met a man while on a business trip who would most certainly have another name if prevailing attitudes were different. He introduced himself as Bingo. I thought he was making a joke until he said it was truly his legal name. He told me that his father desperately wanted a son and after five daughters… Bingo! His wish had come true.

Perhaps one day I’ll meet a woman named Bingo.
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Thursday, July 9, 2009

Keeping Them Guessing

A Sometimes Risky Strategy
Politicians aren't products (exactly) but how would a marketing person dissect the surprise resignation of Governor Sarah Palin? Some take her at her word and others are convinced of hidden agendas. Why this sharp divide?

Some insights might be gained by examining the success factors that allow Apple to use mystery to drive interest and anticipation. Under the leadership of Steve Jobs, they have been brought back from the edge of oblivion to become the hallmark of that intersection between tech innovation and design. Feeding the cachet of the Apple brand has been their clever use of silence and, sometimes, misdirection. (Not so clever was the decision to keep Jobs' liver transplant a secret. True, they probably avoided some potential shareholder panic but disclosure would have been the appropriate path.)

How does Apple pull this off? How can they keep their plans quiet without infuriating their customers, the news media or investors? Sure, there have been glitches but mostly:

They deliver. Their products have been deemed to be worth much more than any of angst or frustration caused by the purposeful stealthiness. And, once a breakthrough device is delivered, they follow through with incremental improvements and extensions.

It's become a sport. With a successful track record and an established method of rolling out "must have" products, they've created something of a game -- a bit of cat-and-mouse. Their publics fill cyberspace with speculation and discussion in attempts to figure out the products' specifications and when they will be delivered.

Their appeal is broad. Frequently representing the leading edge, there is wide interest in Apple's exploits. Sure, there are people who don't care or refuse to get caught up in the Apple aura. But a key to the success of their strategy is that there are few who are engaged in any active dislike of the company or its products.

As for Sarah Palin, the now soon-to-be ex-Governor of Alaska did not directly address her plans during her press conference the other week. In follow up interviews, she repeated that she can be more effective as a private citizen. Also, fighting ethics complaints and the media have taken a financial toll on the state and her family and, because she already decided not to seek re-election, leaving now would be in everyone's best interest.

So, was this about spending more time with and shielding her family, digging out of a financial hole with book deals and speaking engagements, gaining a national platform by becoming a conservative TV commentator, gearing up for a Presidential run in 2012, all of the above or something completely different? While most of us were left to wonder, Republican political consultant Mary Matalin was convinced that Gov. Palin's move was "brilliant." Not so sure were other key Republican figures. Former Arkansas Gov. Mike Huckabee said her mid-term move "simply doesn't make sense" and Karl Rove, former President George W. Bush's counselor, said it was a "risky strategy" if she had any designs on elected office.

Michael Carey took a harder line in his commentary in the Anchorage Daily News: "We are left to guess. The only thing we can be absolutely sure of is this: Palin did not tell the truth when she said she is leaving for the good of Alaskans. She is leaving for her own good."

In response to all of the criticism, Gov. Palin said, "You know why they're confused? I guess they cannot take something nowadays at face value."

So, why isn't she getting the benefit of the doubt? Why is she in a defensive posture and repeating the words "I'm not a quitter, I'm a fighter" over and over? Why is the web overflowing with references to her "epic fail"?

I submit that we can use Apple's success as a guide to help us judge if "keeping them guessing" was a wise strategy:

Has she delivered? She made a stunning entrance onto the national scene with her selection as John McCain's running mate but, it was a bit like a Super Bowl ad with no marketing campaign to follow. While she can take credit for some accomplishments as Governor, there is some consensus that perhaps the most important work in Alaska is left unfinished.

Has Palin speculation become a sport? The Governor has, indeed, generated discussion around the world. However, the substance and tone are not entirely sporting -- not with polls asking whether or not she should run for President or "disappear."

Does she have broad appeal? Most political pundits agree that her support lies only at one end of the political spectrum. This polarization may ensure that an active set of detractors will always be second-guessing her intentions. And, questions will remain about the ethics of asking Alaskans to elect her Governor and then leave in a relative rush just a year and a half later.

The bottom line is that Apple can keep us guessing. They have cultivated their publics and grew from one success to the next. For Sarah Palin, one never knows but, without the time to fully bank political capital or build her reputation and public trust, she may have made one guess too many.

Tuesday, June 30, 2009

A Culture of Complaining

This article also appears in

The Message in Misery
We have all engaged in complaining about something at some time. A bad meal. A crazy boss. A broken gadget. An outrageous bill.

Then, there's competitive complaining. In "Misery Poker: It's One Game Worth Losing," Elizabeth Bernstein wrote recently in The Wall Street Journal that "stressed to the max and desperate for everyone to know it, many of us are trying to trump each other with our carping." She went on to note that "instead of sharing our misery, we seem to be using it as a competitive weapon. ...there are those who use stress as a measure of success."

Perhaps we're seeing complaints in a new light or at a new level with this recession but I've seen this "out-martyring" routine many times before. I remember one notable example that I overheard during a bus ride in Chicago in the late 90s -- one guy said proudly that he had a heart attack at 45, the other guy scoffed and said that's when he had his second heart attack. He had his first at 42.

As a communicator, though, I'm looking for some deeper meaning in our complaints. After all, complaining is a form of communication and, like any exchange, we need to know our audience. Here's my attempt at categorizing complainers:
  • Attention Seekers. This may be the largest category of complainers -- those who may have some unfulfilled emotional need for attention. If there's an unmet need, it might be worth exploring what caused the void, why it may not be getting filled and what it might take to make a permanent (or at least a long-lived) repair.
  • Terminally Annoying. My sense is that there are some people that are just hard-wired to whine. They have to gain some insight, recognize the behavior and devise some tactics to overcome the impulse. Otherwise, we have to cope with it or tune it out.
  • Clinically Complicated. Some complainers would be better categorized as patients with neuroses. Guiding them toward some medical or psychological intervention might be indicated.
  • Pressure Cookers. It can be a scary situation to witness a usually even-keeled person erupting into a complaining rant. It's unexpected, it's out of character. These complainers lack a relief valve that can episodically vent some steam. They need to understand that providing feedback in a timely manner will not diminish their likability and will, in fact, create better relationships.
  • Crowd Followers. Due to a lack of confidence or an eagerness to fit in and be accepted, some people will take the lead of others and join in on the complaining. They need to think more about which crowd they want to be aligned.
  • Signal Senders. In my experience, there is an under-appreciated group that may be making actual attempts to communicate an issue or send an alert but the message is interpreted as a complaint. Rather than brushing it off, it may be worth investigating their motivation or intent.
Sure, complaining can alienate. It can brand us as disloyal. It can lead to stress and, some say, even shorten your life. (According to my mother, however, this was not the case for her mother-in-law. Decades ago when I told my mother that I hoped grandma wouldn't die, she said, "Don't worry. She has so much more complaining to do that she'll probably live forever.") We could and should be reading more into the whines, moans and carping we hear each day but, as Freud might have said, sometimes a complaint is just a complaint.

Between blog posts, I invite you to follow me on Twitter @pauloestreicher.

Monday, June 15, 2009

Observations From the Consumer Genetics Conference

The First and Certainly Not the Last Meeting
I was able to catch the last day of the three-day Consumer Genetics Conference in Boston last week. Part scientific exchange, pep-rally, and company show-and-tell, it attracted about 500 attendees. Jumping to the end, the meeting was concluded with, "See you all next year," though Linda Avey, co-founder of 23andMe, thinks we'll see big changes in the Conference down the road. She likened genomics to the early days of the Internet. "There were conferences just on the Internet," she said. "Now, you wouldn't think of such a thing -- it's ingrained in everything."

So, the future prospect of some sort of Conference occurring next year was assured. I'm not sure the same can be said of this emerging industry. Sure, enormous advancements in genomics technology have been made. Cash has been poured into a variety of companies, though unevenly distributed to be sure. A variety of consumer and medical applications are beginning to take hold. Yet, from what I observed, the overarching question that speaker after speaker sought to address was, "Is consumer genomics ready for prime time?"
Here are some of the challenges I noted:

The Science. There are still worlds to conquer in order to achieve the accuracy, speed and cost required to achieve business success. Then, there are the issues of standardization: how much information is sufficient to associate a genetic variation with a medical issue or outcome, and how do we account for multi-genic contributions to a drug response or disease process?

Investment. In this economic environment, some companies are having a difficult time hurdling over the bar set by venture capitalists for business and financial modeling. Making the leaps from research to development to marketing can be harder and longer than ever.

Medical Education. Genomics needs medical champions yet there is practically no training available for healthcare providers. Interestingly, the Life Technologies Foundation announced that it is teaming with the New York Academy of Sciences to offer genomics training to medical students. We'll have to track this, given the hardening line taken against industry support for medical education.

Public Education. This, too, is a substantial obstacle. What to expect, what to do with genetic information, what the probabilities really mean? "People don't like probabilities," said Talya Miron-Shatz from the Center for Health and Wellbeing at Princeton University. "They like binary - yes/no - information" but that's not what they'll be receiving.

Proving Value. As a corollary to the above points, what does value look like? How can we measure outcomes? Who will pay for genomic tests?

Healthcare Delivery. An important issue, though not addressed specifically, is how to extend the benefits of genomics to all. Carol Isaacson Barash, Principal at Genetics, Ethics & Policy Consulting, Inc. remarked to me that, "were it not for the public's gift [of resources to the NIH], our knowledge would not exist. Given the global interconnectedness of data and economies, ensuring global benefit is, in my view, an urgent need."

But maybe we don't need genomics at all. That's what James Heywood, Chairman of Patients Like Me, envisions -- a "Twitter for medicine" where participants share their health information to "achieve personalized medicine based on phenotype."

It seemed clear, however, that there is enough "there there" to be optimistic. Genomics has and will continue to make an important mark on health and medicine. Mark Stevenson, President and COO of Life Technologies, predicted that genomics will be "a standard tool in the doctor's office in 8-10 years. He sees a model similar to i-Tunes -- a decoupling. The location of diagnosis and the location of treatment will not be dictated by the hospital or the physician but by the consumer.

Stay tuned!

Monday, June 8, 2009

A Chink in Oprah's Armor

Is She Putting Your Health At Risk?
The list of Oprah Winfrey's accomplishments is long. The value of what she brings to her viewers and readers, and to communities worldwide is enormous. Yet, as Newsweek tells it in their June 8 cover story, "Crazy Talk: Oprah, Wacky Cures & You," there is danger in her embrace of alternative therapies -- danger to the public health and danger to her reputation.

The article discusses several cases where both lay and professional health "experts" have dispensed potentially dangerous advice, including the use of Tarot cards to diagnose illnesses, refusal of vaccinations, and self-medicating with hormones, herbal supplements and mega-doses of vitamins. Moreover, Oprah herself has spoken positively about a number of these "treatments" and "cures," providing an endorsement of gigantic proportions.

In response to the article and the condemnation of mainstream medicine, Oprah released a statement saying, "For 23 years, my show has presented thousands of topics that reflect the human experience, including doctors' advice and personal health stories that have prompted conversations between our audience members and healthcare providers. I trust viewers, and know that they are smart and discerning enough to seek out medical opinions to determine what may be best for them."

Let's break this down:

1. Doctors' advice. Yes, Oprah has welcomed quite a few esteemed medical experts who have clearly and accurately described a wide variety of medical conditions and potential interventions. Some physicians and their advice are more equal than others, however. There is a cadre of highly credentialed individuals who have repudiated peer-reviewed data in favor of so-called natural remedies. Dr. R.W. Donnell, the physician blogger, calls them “quackademics.” The article highlighted Christaine Northrup, M.D. who said that, "in many women, thyroid dysfunction develops because of an energy blockage in the throat region, the result of a lifetime of 'swallowing' words one is aching to say." She also said women should consider iodine supplements (which, in reality, will make hypothyroidism worse). Oprah calls Northrup's book, The Wisdom of Menopause, her "Bible."

2. Personal health stories. We all know that information conveyed in a personal, emotional way connects with audiences better than just some dry facts. The flip side of this is that many times the information is less fact than it is anecdote or wishful thinking. Suzanne Somers, for example, speaks to Oprah's audience of her own quest to look younger and double her lifespan with a regimen of non-FDA approved bioidentical hormones and 60 other supplements, which she ingests, applies and injects. Though a personal story, Somers wants to be viewed as an expert. "I have spent thousands of hours on this. I've written 18 books. I know my stuff," she told Newsweek. Oprah said "every woman should read" Somers' books.

3. Trusting viewers. In my view, the word "trust" is just not applicable here. The issue is whether or not her viewers are a) exposed to other sources of information and b) able to differentiate real science from junk science. This is not an issue of smarts, either. The point is that, while there are plenty of intelligent Americans, the vast majority have low health literacy. In a survey of more than 19,000 adults (age 16 and up) conducted a few years ago by the National Center for Education Statistics, only 11% where found to be "proficient" in their health literacy. The majority, 53%, where in the "intermediate range," while 22% had "basic" and 14% "below basic" health literacy. Without proficiency, it is exceedingly difficult to integrate, synthesize and analyze the sometimes complex information that one is expected to tackle.

Is this Oprah's "jump the shark" moment? Her ratings are down as is readership in her magazine, O. But I hope the answer is no. Rather than defend the past and continue on this course, Oprah should seize the opportunity to do better in the future. Please Oprah, ensure that all sides of the medical argument are heard. Leverage your reach and good intentions by being a champion of health and science literacy.

Thursday, May 28, 2009

Hospitals Pushing the Envelope with Social Media

This article also appeared in

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.

Thursday, May 21, 2009

A Spokesperson Goes Off Track

Remember to Keep an Ear to the Rail
Brands have a number of options when it comes to gaining endorsements. Among them are experts, celebrities and people with actual success stories. In the case of the pharmaceutical industry, the last example would be happy, grateful patients. Patient spokespersons have proven to be effective in communicating key messages in an authentic fashion.

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 of Andy Behrman and his relationship with Bristol-Myers Squibb. Mr. Behrman is a person of some renown -- he chronicled his life with bipolar disorder in Electroboy: A Memoir of Mania, published in 2002. It was reported that BMS paid him $400,000 in 2004 and 2005 to talk about the benefits of their blockbuster drug, Abilify(R). Mr. Behrman appeared in videos, at BMS events and in numerous media interviews. He would say how Abilify was life-changing and had no side effects.

Now we hear from Mr. Behrman -- after his non-disclosure agreement lapsed -- that it wasn't true. He said he experienced side effects that were worse than any treatment he had tried and stopped taking Abilify within the first year.

Working with endorsers can be tricky, though BMS reportedly said that every collaboration, except for this one, had 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 80s. 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 proclaiming the drug can cure hangovers!

The WSJ article gives us some insights on how one can minimize the chances of being surprised and disappointed by a patient spokesperson. Here are some principles for your consideration:

  • Dont' 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 end up causing some damage to the reputation of BMS. And, Mr. Behrman's reversal may call his motives into question. On his web site is a link to The Daily News gossip column, Side Dish, from November 19, 2008 that said Brad Pitt and Matt Damon may 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? Or, has he been overtaken again by his illness? It's possible that these are questions that we may not be asking if more thought, care and scrutiny went into the communications planning and review process.

Thursday, May 14, 2009

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.

Thursday, May 7, 2009

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.