Pieter Peach

I’m confused about the potential utility of social media in health, and I suspect I’m not alone. I’ve been struggling for a term to help me articulate my feelings towards the use of the terms “social media” in the context of “health” and “healthcare” for a while. Struggling to the point where I’d avoid conversations for fear of the inevitable twitch in my left eye as I recognise, yet again, that I simply can’t compartmentalise the concepts as well as I’d like.  This is despite malignant curiosity leading me to use most major new communication and technology trends around since Boyz II Men groupies were still teenagers.

Following almost every discussion around the use of social media in health (and healthcare) I’m left with a recurring feeling that people are taking part in the one same conversation, using identical words, but talking about different concepts.  I’m sitting here at the kitchen table after a weekend of anaesthetising unwell patients, trying to crystallise in my own mind what these different concepts are, and how they relate to these unwell patients, their well relatives, and the staff caring for them.

I’ve recently understood that “social media”, “health”, and “healthcare” are best described as a “suitcase words”.  Artificial intelligence researcher Marvin Minksy described “suitcase words” as words containing many different concepts. These evolve to improve the efficiency of daily conversations, but can be singularly unhelpful when trying to match these jumbled concepts to real actions and outcomes. I feel it’s the difficulty in matching of words and concepts during these conversations to real improvements in outcomes that hopeful, but confused, clinicians are struggling with.

Minsky talks about unpacking these suitcase words into the smaller, more actionable concepts.

Lets start with the term “social media”.  These can be roughly unpacked into public networks based on common interests (twitter.com), private networks based on social and organisational relationships (Facebook.com, yammer.com), or mixed public/private networks (google+).  Social media in its essence is networked multi-directional content. Email and chat channels, widely available since the early 90′s fit this description, but various factors have meant that the network effect fuelling the uptake of newer communication tools never developed to the same extent.  Content creation and distribution has since become more efficient with advancements in technology and evolution of culture, and now almost anyone can create content via their affordable devices and data plans with a unique human behaviour that has been “shaped” to share.

What about the word “Health”?  Are we talking about wellness and its tremendously broad determinants, or are we discussing the management of illness (healthcare).

What about “Healthcare”? Lets unpack this to slightly more focused suitcase terms of quality of care, productivity, and branding (staff and patient recruitment).

At a recent Sax Institute forum entitled “Bringing the social media revolution to healthcare“, I sat in a mixed audience of administrators, clinical staff, journalists, private hospital body representatives, marketers, and various other stakeholders in healthcare.  We listened to Mayo Clinic‘s experience of exposing their already successful brand to the unpredictably stormy seas of social media.  I came away thinking that social media led to positive improvements in Mayo Clinic’s brand, as well as improvements in patient outcomes through distribution of information to patients for which Mayo Clinic had the expertise to manage.

I spoke to attendees whose primary interest was in organisation branding and its potential for staff and patient recruitment and who thought primarily about twitter, linkedin, and facebook.  I spoke to health promotion practitioners whose primary interest was in assessing sentiment and promoting behaviour shaping to improve population health through tools such as twitter, facebook, and youtube. The benefits flowing from the evolution of communication has been obvious to private healthcare services and health promotion researchers because their primary roles are to assess sentiment and shape behaviour as marketers, and that’s what the two-way mass communication platforms of twitter and facebook are particularly good for.

I spoke to administrators in healthcare organisations thinking about how to grapple with privacy, legal, and productivity risks. Why their staff would want access to youtube, twitter, SMS, facebook, what they are likely to overshare, and what social media policy documents need to be put in place.

Unwell people are beginning to think about tools to help them connect to people with shared experiences (patientslikeme, curetogether ), illness information produced by experts (mayoclinic, Wikipedia, quora), and the people and services that help them get well (ratemydoctor), as well as tools that improve communication with their clinicians (hellohealth, healthvault, teleconferencing).

Healthy people have picked up on the potential of tools that connect them with people and information that keep them healthy.  They think of twitter and blog streams dealing with nutrition, exercise, and wellbeing. They think of socially connected health metric applications that they hope will positively shape their behaviour (the eatery, runkeeper, dailymile, trackyourhappiness).

Clinicians’ interests at this point in time seem to be in the understanding of the implications of social media tools to them and their patients. They are, for good reasons, unable to provide specific clinical advice through public networks, and the vast majority of clinical staff have no access private organisational communication networks that may improve productivity within their organisation. The default position for people directly responsible for the health outcomes of others is one of well-deserved skepticism. They are unable to crystallise in their own mind which of the jumbled concepts in “social media” would help them do their job better.

Over the next few years communication tools will evolve and clinicians will be given access to communication networks with more appropriate privacy controls for the information being exchanged.  Discussions will also start to focus on narrower and more relevant concepts, and as this happens, the use cases for clinicians and the problems these connected technologies are able to solve should become clearer.

Note: I’d like to attribute the concept of “suitcase words” to @arcwhite and the clarification of behaviour “shaping” vs “change” to @yhpo and @bjfogg

It was suggested to me by the ever clever marketer @sammartino that brands are, for the most part, cognitive shortcuts. Shortcuts that evolved to simplify choice in a world where information was both difficult to find, and then consider properly with our limited brains.

The question is this. What role will branding play as technology progressively compensates (as it already has started to), for these cognitive limitations? Will certain decisions based on functional criteria (financial decisions) become brand resistant, leaving those decisions with image/fashion criteria for the marketers to play with?

“The Machine Stops”, is a dystopian short story published in 1909 ago by EM Forster (free here) laying out a future where a segment of human society becomes terminally dependent on machines. Humanity loses both its capacity, and will, for a life free of technological augmentation.  The highest form of existence is sitting alone in a self-contained, underground room connected to the rest of humanity only through the machine. Ideas and thoughts are valued over first hand experiences of the real world.

Tempting, as it is, to generalise and join the hordes of well intentioned late adopters in claiming that the internet is incrementally isolating us, it might be worthwhile taking a look at what is actually happening around us.

In the same way that transport enabled us to engage more with unseen worlds, online communities are enabling us to engage with people located around us. Location-based applications are just beginning to make their way into our mental frameworks.

A hint of the near future of human engagement was evident at SXSW Interactive this year, where location based applications such as Foursquare and Gowalla began to reach critical mass adoption. With a location enabled mobile device individuals began “checking-in” at various venues, notifying friends and, often, strangers of their location. Up to 200 people were checked in at some locations.

On top of these platforms, strangers are beginning to be connected by matched attributes such as “I’m interested in mobile tech”. Pairwise.mobi was an application built by a two man team in 48hrs on thestartupbus.com which did exactly this.

In the same way that we have somehow miraculously become both comfortable speaking to complete strangers and desensitised to exhibitionism on Chatroulette.com, we will soon be more comfortable with these applications introducing us to relevant but complete strangers that happen to be sharing a venue.

This may well be the “threads of self-denial” referred to be EM Forster, but until technology advances to the point that virtual engagement becomes indistinguishable from physical engagement, we have an opportunity to take advantage of a new era of location-based serendipity.

Do you see potential, or do you think location-based apps are overhyped?

The entire audience was silent after watching Sunitha Krishnan’s powerful TEDIndia talk on the issue of child sex trafficking in India in November this year.  People needed time to digest her message.

She spoke about the organisation Prajwala she began almost 15 years ago in Hyderabad, India, and its mission of helping trafficked children.  Prajwala finds, extracts, and supports women who are trafficked into prostitution as children. I visited her and Prajwala in Hyderabad after the conference to speak to her to understand more about it.

In conversation she displayed an intense, resolute determination, and selfless pride in the activities of the organisation.  She described a multipronged approach aimed at helping these children by providing equal parts psychological support, civic support, and vocational support. She made it clear that none of these approaches alone could achieve the desired outcome, which was full reintegration into their community.

Her organisation worked to table, and have civic compensation legislation for trafficked children passed through Andra Pradesh state parliament to enable their civic rehabilition.  This, she described, was crucial to having the children recognise themselves as victims rather than perpetrators, and crucially, have that same mindshift occur in the communities they were re-entering.

In addition, Prajwala has set up seventeen schools, educating the children through all stages of primary and secondary education.  I visited one of these schools and spoke to a few of the teenage girls, one of which was now in university completing a Bachelor of Commerce.

On the same grounds, they had vocational training workshops in metalwork and woodwork, and were running a printing enterprise. One of the most difficult aspects to deal with was the fact that approximately one out of three girls had contracted HIV prior to their arrival at Prajwala, and medical support was a significant challenge.

Sunitha has suffered both threatened and real physical abuse from the vested interests in child trafficking.  She has been attacked in fourteen separate incidents, and at the time of our meeting, was waiting for an operation required to fix her hearing, from a recent attempt on her life.

The consequences of Prajwala’s work is inspiring.  Over 3,500 children have received support, 600 of which have gone on to marry and have 46 children, who she affectionately described as her grandchildren.  This, by anyone’s standards, is a big achievement.

Watch her talk above to hear it in her own words.

Furniture made by the women at Prajwala

This is concentrated lesson juice from the 10 First To Market Products That lost out to Latecomers from Business Insider.

“1. Friendster took money from a number of large venture capital firms very early on. They promptly filled the board with VC all-stars who had grand visions for Friendster’s future, but little concern for the technical problems of its present. (Friendster vs Myspace/Facebook)

2. Even when you’re a market leader, keep iterating and improving your product. Don’t just make your next product better than your last one, but dream big, and make it better than anything your rivals could come up with. (Palm vs iPhone)

3. If someone bigger and stronger decides to enter your market, you may need to radically alter your strategy. Don’t pretend you can out-muscle them. Find your niche and shore it up. (Netscape vs Microsoft)

4. Always be thinking about whether there is a better way to do what you do. You can be sure someone else is. (Webcrawler vs Google)

5. If your product is popular, but could very easily be merely a feature of someone else’s, you have a problem. Find a way to stay relevant, or convince the makers of the uberproduct that the cheapest way to incorporate your technology is to buy you. (Tivo vs DVRs)

6. If you are selling a platform for content, it’s incredibly difficult to compete with someone who can sell that content to users directly. If you can’t do the same, get out of the way. (Rio vs iPod)

7. Consumers might have a different plan for your product than you do. Adjust your design to fit their needs, not your ideas about what the product should be. (Betamax vs VHS)

8. Keep innovating. Especially if you are in the technology sector, you can’t kid yourself that your product will stay appealing forever, or that serious competitors will never come along. (Atari vs Nintendo)

9. Sometimes your customers’ needs won’t sit well with you; what they want just isn’t the sort of product you wanted to make. If you can afford to fail, stick to your guns. Otherwise, get with the program. (Everquest vs World of Warcraft)”

This is inspiration, purified. Pick a root cause of much of India’s beaurocratic and economic pain, and wrap a simple business model around providing a solution to it.

What you get is a company providing anti-corruption services to people experiencing roadblocks in their dealings with bribery ridden government departments.  This is gold.

This social enterprise is the brainchild of Shaffi Mather and his partners out of India, and I saw him present their idea at TEDIndia in November this year.  Shaffi’s legitimacy in this space includes his qualification as a lawyer, property developer, and founder of 1298 Ambulance, a cross-subsidy model social enterprise successfully making ambulance services available to the people of Mumbai.

He had realised that the cost of providing people with help in tackling bribery, utilising existing Right to Information legislation, was significantly less than the cost of the bribes being requested. Instant business model, with a ready market (~$1 trillion). Just add chutzpah.

Best part is this. On stage, his flippant remark “We could call it something like bribebusters.com…”, led to an email that night by an international paper requesting an interview with him about this “BribeBusters.com” they’d seen mentioned on the twitter backchannel of the TED event.  1. He hadn’t registered the domain name.  2. He didn’t know whether a company with this name already existed. 3. He immediately registered the (surprisingly) vacant domain name once he recovered from his brief panic, fearing a defamation suit from an existing company.

Whether it will be called Stop Bribery and Prevent Corruption, or BribeBusters.com, its a great story. Listen to his talk below.

On my way to TED India I was shown around the Swami Vivekananda Youth Movement activities in Saragur, rural India, by an old friend who worked there as a paediatric surgeon. It was started 15 years ago by 4 medical students from Mysore and comprises two schools educating approximately 800 students between them, and a 100 bed hospital supplying free medical care to the local population.

Even though they were medically trained, they realised early that without education and nutrition they were fighting an uphill battle. The quality of the school was impressive, educating children from age of 2 through to highschool graduation, and boarding about 30% of their chidlren.  There were 30 computers in each school, and although one of the schools had access to the internet, as yet, the remotest of the two schools didn’t. I couldn’t help but think about the resources these kids now had access to through these computers that they used to have to rely on donated books for.

The founders were still working there fulltime as doctors/administrators.

Advice from the many corners of the web seems to be polarised on how free you should feel to talk to people about your “big idea“. Both sides make valid points and take an extreme position to prove a point. Is there a middle ground?

Share-widely camp.

1. Without the idea there is nothing, but execution is everything. There will be plenty of people in the world with the same idea, and success will come to those that have the passion, capacity, and persistence to execute on it. Also, beyond trying your smartest and hardest, much of a venture’s success will just be up to timing or dumb luck.

2. You’re idea won’t develop without talking about it. You need early validation, either from your customers (ideally), or peers (often not critical enough). You will reinforce internal biases if you keep on talking to nobody but yourself.

3. Don’t bother with non-disclosure agreements (NDAs). Investors won’t sign them anyway. They won’t take the liablity exposure by signing your NDA on the off-chance they’re already incubating the same idea with another one of their ventures.

Keep-it-to-yourself camp.

1. You’re idea is valuable and unique. If it wasn’t, then why hasn’t it been executed on before now? The answer may be that it’s a dud idea, it may be that it’s servicing an only recently realised painpoint, or it may be that the market/technology has just evolved sufficiently for it to work. Why risk letting someone else benefit from your ability to generate a good idea? Good ideas are not a dime a dozen.

2. Bother with NDAs. An investor who knows enough about your idea to be interested (and probably enough to realise they’re not invested in a similar space) will bother signing. Anyone else is not interested or serious enough and you should look elsewhere. Here is an example of a VC that signs NDAs, and why.

Devil in the detail?

There is undoubtedly a middle ground as there are plenty of examples where protected ideas have contributed to sustainable competitive advantage, and examples of valuable companies built on branding, story, and customer/distribution networks alone. Most straightforward web-startups with no novel technology to patent probably fit into the latter category and are much better off just getting on with it and executing.

If its not a straightforward web-startup, get questions about protectable intellectual property (IP) answered quickly. How protectable is it? How much will it cost to protect? Are you better off just spending the money on getting your product out? A brief chat to a patent attorney will likely help you get this answer (although consider their vested interest in the patent path).

Getting early advice from people more experienced doers that are currently doing in a related space will no doubt help you refine your idea. Should you lose faith if they don’t get it? No, just work on your pitch. If they do get it, listen and incorporate their feedback as objectively as possible. You will likely sound like an idiot at the beginning. Don’t care, you soon won’t.

As we’re repeatedly told, there is more to IP than patents, and there is more to a business’s value than IP.

The best advice nobody disagrees with? Just go out and do it already.

I’d be interested to hear other people’s thoughts on this. Any experiences to share?

Twitter @pieterpeach