Tuesday, June 30, 2009

A Culture of Complaining

This article also appears in odwyerpr.com.

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.