@SFBIZronleuty captures the essence of Union Square during #JPM15
@SFBIZronleuty captures the essence of Union Square during #JPM15

In 1982, a small group of investment bankers at Hambrecht & Quist launched an investor conference for companies in the biotechnology space. At the time, biotech was still seen as something just beyond alchemy: using genetically engineered bacteria to create a whole new spectrum of medications.

The conference has grown each year, surviving a series of corporate changes that have left the confab in the hands of J.P. Morgan Chase. Once the province of biotech executives and bankers, the early-January event now draws companies across the health care space, along with media, marketers, public officials, entrepreneurs and anyone else with a stake in the future of health.

That expansion means that, every year, we get requests on the best way to “do JPM,” which is like asking for the best way to “do Disney”: there’s no right way to conquer a meeting that has become this sprawling. But over the past few years, there have been thousands of words of guidance penned. Here are the best hints to maximizing the experience:

  • “Meet some new people, some old people, some random people doing cool stuff you know little about. Part of the magic of JP Morgan is the sheer density, and diversity, of people in one place doing so many interesting things.” – Luke Timmerman, #JPM14. The whole thing is worth a read, and I provided counter-commentary here.
  • Be on alert for some white lies (“You guys don’t seem like other VCs”) and relentless optimism (“Really, this isn’t a bubble…”). – Bruce Booth, #JPM14, #JPM15. Naturally, this year in biotech will be different. Really.  
  • “Expect to find eight to 15 events all competing for the same audiences simultaneously, all day, every day, Monday through Wednesday. Then expect to wrangle a last-minute invite to the 50 or so evening receptions every night.” – Chelli Miller, #JPM15. Pretty sure that’s tongue-in-cheek, but I may have met some folks on Tuesday morning who looked like they hit 50 parties the previous night. 
  • “You ‘win’ J.P. Morgan in June, not January. Swapping business cards for four days means nothing if there’s no followup until everyone arrives in San Francisco in early 2016.” – me, #JPM15.
  • “3 things you won’t see at JPM: Some really interesting [private] presenting companies … patients … frank discussions about R&D and ‘worker bees.’” – Ron Leuty, #JPM15. Check the link, which also notes, helpfully, how many steps it would take for meeting attendees to reach the “real” San Francisco: 351 steps to the nearest massage parlor, 240 steps to the scent of urine, 135 steps to the hot dog cart.

Please tweet your best hints. Naturally, use the conference hashtag: #JPM16. And see you at the Monday night tweetup!

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Kim Kardashian taught us all a tremendous amount about the perils of using social media for prescription drug promotion this week, but the real message seems to have been missed by most folks.

The media, who can’t resist an opportunity to write gimlet-eyed hot takes about the reigning queen of famous-for-being-famous, widely reported this week’s news that the U.S. Food and Drug Administration sent a warning letter to Duchesnay, the maker of the morning sickness drug Diclegis, after Kim Kardashian took to Instagram to extol its virtues.

The FDA warning was utterly unsurprising. While Duchesnay and Kardashian took some pains to include a link to safety information, the overall content is clearly a violation of the agency’s longstanding policies and recent guidance. (A link to safety information, once called the “one-click rule” and heralded as the best way to ensure that online promotion offers a fair balance between risks and benefits, has been utterly rejected by the FDA.)

These are not new issues to us. In fact, our expert teams handle social for pharmaceutical and healthcare companies daily. This was a rookie mistake by Duchesnay — or a blatant risky one. With priopriety analytics – including our exclusive MDigitalLife database of social activity by physicians – we drive global pharmaceutical and healthcare-related communications decisions across W2O, including WCG, Twist and BrewLife.

So while the FDA’s rules may be overly strict, they’re no longer that confusing. The Kardashian post, then, reflected some combination of ignorance, recklessness or calculated cunning that the risk of an FDA warning would be worth the flood of attention.

Except that there was never a flood of attention, at least, not the important kind.

It’s impossible to know if sales spiked, but we can look at whether Kim’s post prompted certain behaviors. The easiest behavior to look at is Wikipedia, where site visit stats are public, and where it’s been shown that searches are correlated to drug sales. There, the page for “pyridoxine/doxylamine” (the chemical name for Diclegis) was visited 99 times on the day that she posted her endorsement, rising as high as 148 later that week, as the media scrambled to report on it. (“Morning sickness” barely budged from its historical average.)

Google Trends shows much the same phenomenon: a small spike, but one that looks far less impressive when other pharmaceuticals are included as comparators.

So the net effect was that a post that went nearly 50 million people, many squarely in the young-mother demographic, and received upwards of a half-million likes, drove only a few hundred people to research more about the drug on Wikipedia. As a point of comparison, Angelina Jolie’s mastectomy pushed Wikipedia searches for “mastectomy” from 1,000 to 300,000 in a day: a 23,000 percent increase.

To be sure, it’s possible that enough people skipped Google and followed Kardashian’s web links and the impact was far greater, but the fact that so many eyeballs sent so few people to Dr. Google should raise red flags.

The lesson here is not that FDA rules should be followed (they should, and we can help) but that social media impact can’t be measured on likes alone (we can help with that, too). The Kardashian post was designed to catch the eye of people that mattered when it comes to pregnancy. It turns out that the heads that really turned were at the FDA.

Something unusual happened in Congress in early July — an overwhelming bipartisan approval for a health care bill. But despite the 344-77 vote for the 21st Century Cures Act, the increasingly vocal opposition from oft-quoted critics of pharmaceutical, biotech and device companies should be taken as a warning sign for advocates who want to see this measure become law.

The bill is designed to boost drug discovery and help get patients with rare diseases additional access to treatments and cures, mostly through various reforms of the FDA approval process as well as additional funding for the National Institutes of Health.  (The Regulatory Affairs Professional Society has done a terrific explainer for those who want to dive into the deep details.)

More than 700 groups, from the Alzheimer’s Association to the American Society for Clinical Oncology, to patient-focused rare disease groups to companies and trade associations in the pharmaceutical, biotech and devices spaces, support the Cures bill. That support has shown up in traditional spaces such as Capitol Hill visits, as well as digital campaigns on Facebook and Twitter (#Path2Cures, #Cures2015.)

As it should be, the focus of these efforts has been on the benefits for patients with challenging diseases. Even rank-and-file House members have gotten into the act, such as in this short video from Rep. Reid Ribble (R-WI).

The critics emerge

Yet now with the bill headed to the Senate, that kind of organized support may be even more important. Media-friendly experts such as Rita Redberg, editor of JAMA Internal Medicine, and cardiologist Steve Nissen of the Cleveland Clinic, are being quoted in articles criticizing the Cures bill. The New York Times’s editorial board, often taking cues from the opposition groups, criticized the legislation last week, though it stopped short of saying the entire effort should be scrapped.

The challenge now for those who want to see the bill through the Senate – in addition to trying to avoid big arguments about petty differences as the process unfolds — is to continue to emphasize the real world impact the bill would make. Patients who could benefit from expanded access to “compassionate use” of drugs should be front and center. Groups who want to see “patient experience data” folded into regulatory decisions – because different patients may have different risk tolerances – should be talking more often. And, to reflect the widespread backing for increased research funding that is in the Cures bill (nearly $9 billion extra for the National Institutes of Health over the next five years), scientific experts should be explaining over and over the need for new discovery.

Where are the physicians?

A quick review of our MDigitalLife database—a validated list of U.S. doctors with digital footprints—suggests that physicians aren’t out in droves driving the conversation. That means some of the most trusted voices on the subject of medicine haven’t been heard from yet, and doctors could yet shape this debate. Communicators trying to line up new wrinkles for the continuing campaign to pass the Cures bill should consider engaging with physicians. As our colleague Greg Matthews has written, physicians are not only active on social media, they often influence news coverage.

Conversation about the Cures bill seems likely to spike again in mid-September, when a hearing or hearings could be held in Senate committees. We’ll continue to monitor and look for new and old voices influencing the debate as action develops over the fall. Senate leaders have signaled that they will write their own version of a Cures bill, which could extend the discussion about this legislation until early 2016.

Reporters covering the legislative process will likely focus on the lobbying effort and the political clout of the industries backing the bill. This makes the real world stories – and the use of paid, earned, shared and owned content online – even more important for a successful campaign in the months ahead. The next treatment or cure could be dependent on it.

By Gary Karr and Brian Reid

Later this week, the American Society of Clinical Oncology Annual Meeting will kick off. Earlier in the month, research from W2O Group was published by ASCO, examining the use of social media by physicians. It’s an endeavor that will be extended later this week when we release our third Social Oncology Project report.

Our research found, unsurprisingly, that there is a lot of chatter by physicians about cancer on Twitter.

Nearly 140,000 tweets mentioned one of dozens of cancer-related keywords, and more than 5,000 physicians took part in this rolling, public dialogue. But we should be well past the point of being amazed that physicians are taking to social media; it’s a rare professional organization that doesn’t see Twitter use as a key tool to educate physicians and other doctors. For both practice management and public health, engagement on platforms such as Twitter can no longer be ignored.

But in looking deeper, we found that all voices are not equal in conversations about cancer. While those 5,000 doctors all tweeted at least once, there was an elite group of 19 who recorded more than 1,000 cancer-related tweets over the course of the year. That’s a milestone that is impressive, but almost baffling: these are, generally, in-demand oncologists with demanding day jobs. Where are they finding the time to dash off dozens of tweets a week?

So we asked. And here are the answers.

website_photo[1]DR. DEANNA ATTAI, Assistant clinical professor of surgery at UCLA, president of American Society of Breast Surgeons:

We know there are huge knowledge gaps and we feel it’s our duty of sorts to try to close that. I think also for me–and this accounts for the volume–is that my audience is both patients/public and docs, where many docs don’t interact much with the patient communities. It’s a real challenge as I do have my true day job (patient care) as well as my new job (ASBrS president) but I just think it serves too great a need (perhaps an inflated sense of worth?) to just let it go. There is satisfaction is seeing patients have their questions answered, become empowered, and then get to witness them mentoring and educating others. And the the satisfaction for MD engagement is seeing docs transition from being social media skeptics to the “ah ha” moment when they recognize the value.

ago1KktK[1]DR. MICHAEL FISCH, Medical director of medical oncology for AIM Specialty Health:

I find that I am able to use twitter as a way to find useful information that cuts across broad topics in oncology. For example, given my interest in cross-cutting oncology topics, how else might I expect to keep up on this array of information? Twitter allows me to harness my colleagues to guide me, through their mentions and retweets, to high-value articles and influential pieces in the lay press. Of course, there is some initial “activation energy” that it takes to learn any new thing (like a new kind of smartphone), but once you have the basics figured out, things get very efficient.

7c2b2cf6756ab7535e0184962d9f6bea[1]DR. JACK WEST, Medical oncologist and founder/president of cancer education nonprofit GRACE:

The main motivation sharing information is that this is the information that I appreciate getting from other people. I have learned a lot from tweets I’ve come across, I want to share the things that I think are of value to other people. There have been many practical benefits as well, such as developing relationships with various thought leaders in oncology through twitter, finding at least one of the board members for GRACE (Sally Church) via Twitter, and even ultimately being selected as web editor for JAMA Oncology largely because of my online presence. But at the end of the day, the primary motivation is just to share information that you would want to receive yourself. We want to be valuable contributors to our community, in this case an online cancer community.

To track what Drs. Attai, Fisch, West (and thousands of other oncologists) will be discussing on Twitter during #ASCO15, please subscribe to W2O Group’s “Complete Response” newsletter, delivered every morning of the conference. Complete Response will curate and package the tweets and links most-shared by the most important group of ASCO attendees: oncologists. 

The J.P. Morgan Healthcare Conference kicks off on Monday. It’s the one that everyone in biotech has circled on their calendar a year in advance. It’s not because there is a frenzy of news; journalists operate under the assumption–usually correct– the week ahead of the conference is for news, while the conference is for speculation, drinking and networking.Brians Post

But amidst the smog of gossip, there are a few absolute truths:

1. Whatever is Hottest is Almost Certainly Overhyped. Each year, there is a technology or therapeutic area that ends up being on the tip of everyone’s tongue. Last year it was nonalcoholic steatohepatitis. Past years have seen hyperventilating over RNA interference or Obamacare. Some of these stories pan out. Some don’t. But the level of volume at J.P. Morgan is a lousy crystal ball.

2. Those With the Most Interesting Perspectives Don’t Make Drugs. J.P. Morgan is about looking into the future (“the outlook for 2015” will appear about a hundred thousand times in stories and analyst notes around the conference), but the folks who has the most invested in accurately describing the future of medicine tend to be the ones delivering the care, not the ones delivering the drugs. The not-for-profit track, filled with hospitals and health systems, often paints a far more fascinating picture of the future than biopharma does.

3. Breakouts > Presentations. There is something special about seeing questions asked face-to-face, with no script. That’s what happens in the cramped breakout rooms. So the folks who really want to go deep slide out of presentations 10 minutes early and grab prime seating in the breakout room.

4. Parties Are Irrelevant. People Are Not. J.P. Morgan novices tend to get worried about getting into the “right” parties; an informal look puts the shindig count somewhere in the 70s. But there are no “right” parties (unless you have an independent interest in, say, circus performers or Scotch being served by gentlemen in kilts), only “right” people to see. If you know who those people are, you’ll be fine. If you don’t, no amount of party-hopping will help.

5. You “Win” J.P. Morgan in June, Not January. Most people judge their J.P. Morgan performance by the number of meetings they hold, and most attendees would be happy to share the precise number of one-on-ones they’ve booked. But swapping business cards for four days means nothing if there’s no followup until everyone arrives in San Francisco in early 2016. The players who use meetings as a springboard to a phone call in February, a lunch in March and deal in June are the ones who maximize their time. Quality, not quantity, people.

Look forward to seeing you all there.

Tweet from JPM

We’ve captured Twitter highlights from the first day of the 31st J.P. Morgan Healthcare Conference, held here in San Francisco. Check them out!







Number of tweets:
There have been more than 1,600 tweets using #jpm14 before noon on the first day of the conference.

Most prolific tweeters so far:
1) Rob Wright, Chief Editor, Life Science Leader magazine (@RfwrightLSL), 77 tweets
2) Adam Feuerstein, The Street (@adamfeuerstein), 62 tweets. He also has the most mentioned handle with nearly 150 people mentioning it in their tweets.

twitter@ mentions:

Most are primarily journalists with J&J Innovation being the only company (26 mentions) in the top 10.

Top cashtags:
Celgene made a big splash with their presentation this morning, inspiring 110 tweets with their cashtag $CELG
Alynylam (66 tweets), Sanofi (37 tweets), Seattle Genetics (29 tweets and Merk (24 tweets) round out the rest of the Top 5 most mentioned cashtags

Most retweeted tweets:
Roche   Big news: Dr. Sandra Horning named our new CMO. Here’s her story  #JPM14
Adam Feuerstein   My #JPM14 live blog is up —>  Tweets and updates thru-out the day. Please visit regularly.
 Luke Timmerman   What Biotech Pros Will Be Chirping About at JP Morgan This Week  #JPM14

14 Posts to Take You Into 2014

A year ago my colleague Aaron Strout did a nice wrap up of the most interesting/appealing posts of 2012 on this blog. As Aaron noted, reviewing which posts resonated over a period of time can be informative to better understanding the interests of customers/employees/followers. By collecting the top performers in one place, I’m hoping to provide you with some relevant content you may have missed during the year. Like last year, you’ll notice some themes here – rankings, how-to’s, and analytics-based posts, in particular, continue to resonate.

In 2013 we’ve seen a marked increase in the frequency and number of colleagues contributing to this blog, which is great. And, with 50+ posts having over 2,000 views each, we had to be more restrictive with this wrap up than in the past. As a result (and with a goal of keeping it to less than 15), this year’s list is ranked based on the number of post views – with a minimum of 3,600 views required to make the cut. Of course, there are a ton of other great posts and I encourage you to go back and read these from Bob Pearson, Jenn Gottlieb and Jim Weiss. (Selfish plug, you might also want to read my post-ASCO blog post.)

This year’s list brings us some familiar faces – like Chuck Hemann and Brian Reid as well as some new comers to Common Sense such as Michael Brito and Michael Westgate.

So here it goes – our top posts from 2013 to take you into the New Year:

And the number 1 post of the year – with over 35,000 views…

#SXSWPickUpLines by Aaron Strout (35,847 views!)

I hope you’ve found this list helpful and that you’re looking forward to more engaging content in 2014!  What do you think? Are there topics you’d like us to cover? Interviews you’d like to see?  If so, please let us know in the comments below.

“It’s not about ‘best practices’ – it’s about ‘next practices’ as learned my new colleague Annalise Coady and I, when we excitedly touched down at the W2O Media and Engagement Summit in Austin.

We knew we worked with some forward-thinking people, but the depth and breadth of experience (along with general awesomeness) blew us away. Here’s a quick and dirty summary of some of the things we learned and plan to pioneer across the pond:

  • Media has evolved and PESO is the future: Day 1 kicked off with Head of Earned Media, Jim Larkin, demonstrating how media has evolved from the 1960’s, and how we as communicators have had to continuously adapt in order to connect with our audiences in new ways. Jim introduced the PESO (paid, earned, shared, owned) model – the integrated future of media engagement for W2O.
  • Relationship is king – know your influencers and tailor your pitch to suit: Ex-reporters Ryan Flinn and Brian Reid, along with Earned Media Director Peter Duckler and blogger aficionado Carla Clunis, shared their insights into ‘What Modern Media Want’. The clear message being we must become part of the community we want to influence and ensure we’re always approaching media with meaningful and relevant content.
  • Bring in the experts, right from the start: When you see an opportunity for our client to integrate, deploy our experts across digital, social, creative and media fields.
  • Jump in the pool: Your career at W2O doesn’t have to be linear. Do great client work and pollinate across the company, teaching account teams to do what you do.
  • W2O’s new search capabilities are awesome: Creating content that’s not findable in search is almost meaningless. W2O Search, championed by Greg Reilly and Sri Nagubandi, enables us to ensure we’re always producing content that meets the needs of our audiences – and most importantly, can be found!
  • Influence can be created – passion can’t: 92% of word of mouth still happens OFFLINE. We have the capabilities to execute outstanding WOM campaigns allowing us not only  to keep track of what people are saying about brands online and offline, but also enabling us to insert ourselves into the conversation through the engagement of ambassadors to spread goodwill.
  • Our clients are looking for first class ideas, strategy and execution: As part of a panel discussion, ex-clients Jim Larkin and Lionel Menchaca shared what they look for in an agency:
    • Passionate and committed to the cause as they are
    • Know the ball park they’re playing in
    • Competitive zeal
    • Always offer strategy and counsel where possible
    • Constantly align agency work with client business objectives
  • W2O knows more about what physicians are doing socially than anyone else in the world: Sounds like a heavy claim, but our MDigital Life database has made it so – just ask Greg Matthews!

As a company at the forefront of innovation, we must continue to push the boundaries of conventional approaches; experiment and practice truly integrated planning for our clients, or as they say in Texas; “Always drink upstream from the herd!”

About two weeks ago we launched The Social Oncology Project.  As that project (and subsequent report) came to life, our focus was on uncovering insights by analyzing the numbers.

While we found the data interesting, we wanted to go a step further and include expert opinions because we think the stories of how social media gets used are a critical component to understanding where these tools are headed.  With that in mind, we headed to Chicago to speak with physicians, advocates and industry representatives about their use of social media.  Here’s a look at some of the things we learned:


  1. While some are more timid than others when it comes to social media, physicians are not afraid to get online.  Many recognize that it is a powerful tool for monitoring/tracking conversations and, in fact, a certain percentage is actively engaged in their field of expertise AND outside their field of expertise.
  2. One of the biggest barriers to physician use of social media appears to be time constraints/ competing priorities in their daily routine.
  3. If you’re interested in ASCO, there are definitely some ‘must follow’ people on twitter – and @MaverickNY and @adamfeuerstein  came up more than a few times.
  4. Social media is playing a significant – and still growing – role in patient education.  We heard about patient resources, educational videos, and group forums being shared online by The PAN Foundation,  Johns Hopkins , and Malecare, respectively.
  5. When it comes to social media, the pharmaceutical industry has made great strides over the last several years.  However, the lack of industry guidelines cannot continue to be an excuse from engaging with patients through channels they are active on.
  6. In the future, the use of social media within healthcare will become the norm. As platforms such as twitter become second nature, they won’t be considered time consuming and some believe social media will make its way into medical school curriculum.

For more information about ASCO 2013, check out these posts by colleague Brian Reid and friend Geoff Curtis.

You can view the full Social Oncology report, interviews and media coverage here:

Click for full report

2012 was one heck of a year for new treatments against various different forms of leukemia. In the span of 5 months, the U.S. Food and Drug Administration approved four novel therapies. Drug approvals always come with a spike of media attention, but we at W2O Group have been curious as to how that flood of interest compares with other events throughout the year, not only in news, but in all of the other conversations we have online about cancer.

This is of special interest this week, as thousands of oncologists, patients, advocates and journalists begin arriving in Chicago for the annual meeting of the American Society of Clinical Oncology.

So we decided to look into how we’re talking about cancer, both at the broadest level and in the context of more specific cancers and more specific communities. We’ve collected the results of this analysis in a new report, the Social Oncology Project, that seeks to draw conclusions from hundreds of thousands of tweets, news stories, blog posts and forum entries. We looked both at overall mentions, as well as how doctors talk about cancer, relying on our MDigitalLife database of verified doctors active online.

Our analyses found both encouraging news about the nature of the online dialogue about cancer, as well as some more concerning findings. For starters, there’s no question that we’re talking about cancer. A lot. In the last year, more than 16 million articles, posts, tweets and entries about cancer found their way online in the United States. That’s a lot of talk, and a testament to the impact of awareness raising campaigns.

In fact, there is a direct correlation between awareness campaigns and online conversations. Overall mentions of cancer rise in October due to a surge in posting around Breast Cancer Awareness Month. But similar, if smaller, increases can be seen in almost every cancer type. Lung conversations are highest in November (Lung Cancer Awareness Month). Mentions of colon cancer rise during March (Colon Cancer Awareness Month). Prostate volumes are up in September.

Not surprisingly, the most-talked-about type of cancer is also the one with the biggest awareness push: breast cancer. More people are talking about breast cancer than the other four of the five largest cancer killers combined. (Lung cancer, which kills more than four times as many people as breast cancer, has only 20 percent of the dialogue of breast cancer. Colon cancer, the number 2 killer, has only 10 percent of the conversation compared to breast cancer.)

The larger question of what is driving those conversations, however, paints a muddier picture, one that may be best illustrated by looking back at leukemia conversations. The unprecedented string of new drug approvals in the second half of last year didn’t create so much as a blip in the overall number of online conversations about blood cancers. But football did: when Indianapolis Colts coach Chuck Pagano announced that he had been diagnosed with acute promyelocytic leukemia, mentions shot up tenfold. The next big spike in conversations was also football-related: when the story of Notre Dame linebacker Manti T’eo’s fake girlfriend – who T’eo had said died of leukemia – broke.

Click to enlarge

That’s not to say that celebrities and awareness months are the only drivers of attention, nor that the attention in one medium (say, Twitter) is reflective of discussions in others (say, online news). But, overall, we remain a social bunch online: raw data and “new chemical entities” from the FDA might not move us to share and reflect online, but human stories, be they in the news or those we hear from our friends and colleagues during awareness events, have a way of engaging us.

When I was in journalism school in New York, in the 1990s, one of my classes took a field trip to Bloomberg News, then an upstart wire service. After our tour, we had a q-and-a session Bloomberg’s editor in chief, Matt Winkler. The first question to Winkler was a good one: what was Bloomberg’s best scoop in its young history. Winkler’s response was immediate: one of his reporters was the first to report that tobacco companies were in settlement talks with state attorneys general. As I remember Winkler’s tale, the reporter had literally tracked down top attorneys general in the woods, hurried back and filed the story on a Saturday night. It was hours before the competition matched the news, a major feather for Bloomberg.

“But wait,” my classmate interjected. Who, exactly, was reading the Bloomberg wire at 11 p.m. on a Saturday night? Or, to be cliched about it, if a story breaks in a forest and there is no one to read it, does it really matter?

The famously tempestuous Winkler’s face reddened. “You’d better believe Ted Turner is watching our wire on a Saturday night.” Pause. “Or he pays someone to watch us!”

Winkler’s point was simple: important people read what Bloomberg had to say. Readers paid tens of thousands of dollars to be in the know, and Bloomberg was 100 percent dedicated to serving that small group. They didn’t need a million eyeballs. All they needed was the attention of Ted Turner and a handful of other moguls, execs and investors. And for those folks, the tobacco scoop justified the cost of the content.

I’ve been thinking back to that early interaction with Winkler lately as the evidence has piled up that the future of the newspaper industry will be funded on the back of digital subscribers: those who have anted up (or will ane up) to be let through a paywall. The Pew Research Center’s Project for Excellent in Journalism says that 450 daily newspapers in the United States have a paywall in place. And Newspaper Association of America said that digital-only subscription revenue jumped 275 percent last year. Ladies and gentlemen, we have a business model.**

This has major implications for how we can examine influence online. There’s still an assumption that the valuable content is the content that’s shared (for an in-depth look at the future of viral news, check out the New York profile of BuzzFeed), but creating viral isn’t the only way to success. The other path, the Bloomberg-esque path, is to create content that’s so valuable that people will pay for it. The knee-jerk reaction used to be that, in a world of nearly infinite information sources, no content was worth actual cash money when there were free alternatives. But that thinking is out the window, disproved by the 640,000 New York Times digital subscribers, the 1.3 million Wall Street Journal digital subscribers, and the thousands of readers at smaller papers who are also voting with their pocketbooks. (Heck, the Rutland (VT) Herald has 5,200 digital subscribers. Not bad for town with a population of 4,954.)

This is good news. It frees newspapers, somewhat, from the tendency to serve up stories that are “viral” or “shareable,” which is altogether different from what is influential, in the traditional sense of the word. As I write this, the most-shared Buzzfeed post is a series of photos of a baby surrounded by bulldog puppies. The New York Times’ most-blogged content over the past week, in contrast, was a preview of President Obama’s budget. People who follow the Buzzfeed trends are likely to be popular with their friends on Facebook, but are going to have a limited impact on society. Those who are reading paid content, on the other hand, those are the people who will be busy moving the world.

(Of course, paywalls are porous and, of course, nearly all web content remains free. But in an era where quick decisions and in-depth information are increasingly prized, those who find workarounds to search for information will be at a disadvantage to those who have it delivered, fresh and unrestricted, to the device of their choice.)

The rise of paid online content and, more important, the rise of an influencer class that is consuming this information, has the potential to re-shape online authority, putting power back in the hands of those with the credit cards. In 1997, when the Bloomberg settlement story broke, the most influential people in the tobacco world were the ones who paid thousands of dollars to have a Bloomberg Terminal on their desks. Today, as in 1997, if you want to be an influencer, you’re going to have to pay for it.

** I’m ignoring the fact that the growth in subscription revenue doesn’t come close to offsetting the still-plummeting advertising revenue. There will clearly be more pain in the years to come. But it’s also clear that subscription dollars are likely to be a stable source of revenue for the foreseeable future. 

This weekend, thousands of digitally savvy professionals will descend on a city that has become synonymous with high-tech innovation. They’ll clog Twitter feeds with the conference hashtag, overrun local watering holes, and swap crucial new insights.

And it’s not SXSW.

The American College of Cardiology meeting formally kicks off tomorrow in San Francisco. Though the use of social media by doctors has been skyrocketing over the past 24 to 36 months, it’s the cardiologists that seem to be adopting new tools the most quickly.

To help illustrate the point, the W2O Group analytics folks did a simple search of a sampling of the top medical meeting hashtags, looking at chatter from seven different conferences (see chart). While the meeting with the most tweets was the giant American Society for Clinical Oncology meeting, the ACC meeting was a close second. And with a third fewer attendees, ACC actually had the highest tweets-per-attendee ratio of any of the medical conferences we looked at.

So what are the cardiologists doing right? It’s started with continued and aggressive use of social media by ACC itself. The communication staff is active online. The Facebook page is filled out. And they’re not just pushing a one-way, online-only vision of communication: ACC is hosting an official tweetup on the event floor on Sunday as a way of deepening the connections between the cardio-twitterari. (There’s an “unofficial tweetup,” too, at a local watering hole.) And it’s not just the ACC. The American Heart Association topped the ShareCare Now list of online influencers about heart disease.

Not that the cardiologists need much help from professional organizations. It’s a rare medical specialty where the opinion leaders are also active online. But Harlan Krumholz, a well-regarded professional from Yale, has a home for his opinions at When Eric Topol from Scripps talks on Twitter, scores of patients, media and other doctors take notice. And Farris Timimi from Mayo is a social media dynamo.  And it’s not just the household names: in preparation for the meeting, a number of (mostly) younger docs have begun collecting Twitter handles and blog URLs to better track the zeitgeist of the next few days.

The success of the online cardiology community provides a roadmap for specialties interested in growing dialogue online, and alliances between savvy docs, wired-in advocacy groups and a loose collection of patients, companies and reporters is already changing information flows at other meetings.

The increasing volume of online chatter poses no risk the meeting itself; it’s complementary, rather than competitive, augmenting real-world chats in the hallway with virtual ones. In a world where more discussion and more awareness leads to better care, that’s nothing but positive.

* This analysis isn’t perfectly precise; other events may use these hashtags, and other hashtags may be used for a given conference. The seven meetings selected, however, appeared to generate the lion’s share of traffic around the hashtags examined. 

How #SXSW Tweeters Connected Last Month

Next week, the South by Southwest — known now mostly by the moniker “SXSW” — kicks off. The pedants might correct me on that one: SXSW is actually three separate, though overlapping, events: the interactive conference portion, a music festival and a film festival. But even that’s not quite right:  SXSW can be further subdivided. SXSW Interactive, for example, has 17 different “themes,” from health to government, spread across more than 70 different locations spread across nearly four square miles.

But that doesn’t get at all the divisions. SXSW is only thinly defined by the actual conference and festivals themselves. Only 40,000 or so badges are given out, yet the flood of people who make it to Austin is measured in the hundreds of thousands. There is no ticket required to sip Shiners and skip from private event to private event. (If fact, we’d love it if you dropped by ours.)

I wanted to take a closer look at the different subcommunities that will be gathering in Austin, grabbing 20,000 or so tweets with the #SXSW hashtag last month and running it through an analysis that looked at 12,000 connections between #SXSW tweeters. The analysis spit back yet another number: 562. That was the number of separate communities that seem to exist around the single hashtag. While one was enormous (focused on the official SXSW handle and some high-profile individuals), the rest of the groups were smaller than 50 people. Most were smaller than 10. (The spiderish image that accompanies this post shows what that network looks like. Click to see it in detail. It works best at 6,400 percent zoom.)

Those who have hung out at SXSW won’t be surprised: you rarely see groups of more than 10 clumped around the bars on Sixth Street, and those clumps tend to move together, from sessions to beers to dinner to beers. Sometimes they’ll meet other, similar clumps. But that’s the extent of it. If SXSW has a weakness, it’s that the variety of opportunities is now so great that it’s easy to break down into ever-smaller groups, diminishing the magic that made SXSW special in the first place: the sense of serendipitous encounters with a genius in some distant — but not entirely unrelated — discipline.

There’s plenty of advice out there for first-time SXSW-goers, and it’s all good. But I’d like to offer some advice to the grizzled veterans of Austin: use your experience and position of authority to break up some of those clumps. If you’re the type to go to presentations, take half a day, find the bus and go to a theme that has zero to do with your day job. Find a presenter in that other building and buy her a beer. Go to one party alone.  Drag one of those new friends to your shindig. Buy a tequila shot for a stranger.

The growth of SXSW has been wonderful: it’s pulling a delightful and increasingly diverse crowd, which should (in theory) amp up the opportunities for serendipity. But, at the same time, the structure of the meeting makes random encounters more difficult. I’m not under the illusion that a couple of party crashers or a half-bottle of tequila can instantly change the culture, but it’s a start. After all, a little tequila never hurt anyone.

Via Flickr user KYZ

Last week, the Journal of the American Medical Association published a critical piece, titled “Restoring Confidence in the Pharmaceutical Industry.” It laid out a set of four generally common-sense solutions (with one exception) that would indeed bolster faith in data, if nothing else.

The piece called for independent data analysis, independent drafting of publications and public dissemination of data to qualified investigators, all efforts that are ongoing in the industry. The final recommendation was a suggestion that direct-to-consumer advertising be delayed until some point after a drug’s approval, an evergreen topic of debate.

But it wasn’t the black-letter guidance that make the piece worth reading. It’s a single paragraph, presented without any recommendations, that might be most important when considering how to “restore confidence”:

The pharmaceutical industry is confronted by other challenges. Society has become increasingly risk adverse, and patients are less tolerant of even rare adverse outcomes, which may not be detected even in large-scale randomized clinical trials designed as “efficacy studies,” with highly selective populations. But because virtually no drug is entirely safe, rare adverse events are inevitable, and some serious adverse events might not manifest until the drug is used in less carefully selected ‘effectiveness’ patient populations that characterize clinical practice. (Emphasis mine.)

All drugs carry some risk, the question is whether the benefit of treatment is enough to outweigh those risks. This is a dynamic process: some individuals may find, either because of the variation of disease, the variation of genetics or the variation of risk tolerance, that a certain medication isn’t worth the tradeoff. Others may come to

the opposite conclusion. It’s a delicate dance, done in partnership with a health professional; it’s no coincidence that the U.S. Food and Drug Administration sometimes goes years without letting a prescription drug be sold over the counter.One of the fundamental challenges, then, for those of us who work in this industry is trying to educate the public about risk, both what we know and what we don’t know. This isn’t easy work. There is a tendency for people to overestimate rare risks and discount common ones. Understanding variations and confounding information is also difficult, and it is made more so when there is – as is common – incomplete information.

Just because those discussions are difficult doesn’t mean we should avoid them. Every company should be ready for a full discussion of risk with every stakeholder: patients, providers, insurers, advocates, media and other. But this discussion can’t take place in a vacuum. A conversation about risk discussion has to be accompanied by a conversation about benefits. This, too often, gets lost. There is a tendency to talk about a “wonder drug,” ignoring the downside. Then, when new risks emerge, we fail to put those risks into the context of the benefit. No wonder consumers are confused and society is becoming more risk-averse.

Talking about risk is risky, particularly because we, as humans, are so bad at assessing it. But when it comes to restoring confidence, pretending risk doesn’t exist is the riskiest strategy of all.

Last week, the Pew Internet & American Life Project dropped one of their wonderful reports on the use of the Internet for health. It’s incredibly dense with data, and if you’re in the digital health industry, you can expect to see facts from the report in your PowerPoints for the foreseeable future.

But there’s one fact that marketers might be slower to pluck out of the Pew report, but it’s worth highlighting anyway. Pew asked respondents: “… thinking about the LAST time you went online to look for health information… How did you begin looking?” Seventy-seven percent responded with a search engine, 13 percent cited a health information site and 2 percent cited Wikipedia or something similar. Limping in at 1 percent was “at a social network site like Facebook.”

Put more hyperbolically, people are 1,200 percent more likely to use a health information site to begin their search for health information than social networking. They’re 77 times more likely to pull up Google, Bing or the like. Social networks rank below “don’t know” in terms of a starting place for information-seeking.

To be sure, this isn’t entirely surprising. The architecture of social networks isn’t designed to make specific, factual information available quickly and easily. That’s not a health-specific issue, either: when I want to check cooking times for broiling fish, I don’t pull up Pinterest.

Yet much of the discussion about engaging on social media in the digital health space is focused on bulking up the information available on those platforms: creating fact-stuffed infographics or well-referenced status updates or compelling, actionable tweets. In short, a lot of strategy is focused on content. The Pew findings suggest that such efforts are lost, at least lost on those in the early stages of their health journey.

At the same time, there is a flowering of examples of social media being used to create patient communities and support services. I’ve talked about #BCSM before, but it’s worth pointing that gang out again. The diabetes community is tightly connected by social media. Lung cancer advocate Jennifer Windrum used Facebook as a platform to raise $35,000 to give sock monkeys to cancer patients. And that’s to say nothing of health-specific communities that run the gamut from CaringBridge to PatientsLikeMe.

Those examples, contrasted with the Pew data, illuminate the benefit of social media in health: not as a standalone information source, but as a connector of individuals. That’s advice that’s dangerously close to sounding cliched, but it doesn’t make it wrong. And there’s no doubt that the next time I sit behind a keyboard with the intention of banging out some sort of health-related missive, I won’t ask: “will this make patients smarter?” Instead, I’ll ask: “will this bring patients closer together?”

The J.P. Morgan Health Care Conference is over, and the crowds have dissipated from all of the conference’s hotspots: the hallway outside the Colonial Ballroom, the bar at the Clift, that Starbucks around the corner. The crowds, too, have left Twitter. This year, more than 9,000 tweets were posted referencing the #JPM13 hashtag, more than tripling last year’s chatter. With so much said, we thought that sifting through the information could give a unique perspective on the biopharm confab.

To figure out what ideas really stuck, we pulled the 10 most rewteeted lines of the conference. Here they are (and what they say about the meeting):

@genentech: “Nice antibody. Wanna conjugate?” #jpmpickuplines #jpm13

San Francisco Business Times reporter Ron Leuty started the pick-up lines meme, but it was a perfectly crafted tweet from Genentech that stole the show: on-topic, geeky and surprising. When companies show their human side, they win, and Genentech proved that this week.

@lindaavey: “Don’t call it big data, call it good science” Lon Cardon, GSK. #BigData #JPM13

Big data was a big deal this year, and so was big pharma. With venture money harder and harder to secure, all eyes were on how cash-rich pharmaceutical companies would play the biotech wave. The Cardon quote came from a thoughtful FierceBiotech breakfast panel.

@2healthguru: ‘With healthcare reform we are positioned to perform well..’ Greg Roth, CEO @TeamHealth #jpm13

This tweet proved that Twitter can be a perfect niche medium. Though the TeamHealth tweet picked up plenty of RTs, it was mostly by little-followed accounts. The company may not have made waves at J.P. Morgan, but the people who needed to see the news saw it.

@ceels66: Every orphan drug co presentation I’ve been in at #JPM13 has been packed. Super hot space rt now so obvi we’ll be doing panel at #BIOCEO13.

Some trends are too clear to ignore. 2012 was a year where some new mass-market drugs ran into trouble, but I’m not sure anyone has ever written the phrase “struggling orphan-drug maker.”

@illumina: #HiSeq2500 enhancements in 2H13 will support 2×250 bp, 300 Gb in rapid run mode #JPM13

Illumina knows its audience. They know their audience, and even if the Wall Street Journal wasn’t paying attention to their technological improvements, plenty of genomics researchers were.

@daphnezohar: Widget to track twitter conversations around the 3 HC conferences in SF this week: #JPM13 #BTS13 @appeering

@appeering, which powered my post on Monday, was definitely the most-buzzed-about Twitter-tracking tool of the conference. And when you have 9,000 tweets, anything that turbocharges the sifting process is a blessing.

@illumina: Illumina acquires SF-based Moleculo Inc., for novel sample prep & analysis, synthetic read lengths up to 10 kb #JPM13

Illumina is the only Twitter handle to appear on the list twice. But check out the level of engagement in their Twitter feed: it’s clear that the company understands that Twitter is a two-way communications channel.

@DrJoonYun: Healthcare needs a design thinker like Steve Jobs to disrupt our industry. #JPM13

Yes. Yes we do.

@rleuty_biotech: “It’s not the size of the clinical trial that counts — it’s the outcome.” #jpmpickuplines #JPM13

It’s only fair that Leuty made the top-10 list, given that his pick-up lines brainchild dominated the meeting. About 1 in every 10 #JPM13 tweets was a pick-up line.

@adamfeuerstein: My preview of next week’s J.P. Morgan Healthcare Conference #JPM13 $$

TheStreet’s Feuerstein was again the digital hub of the meeting. No one tweeted more, garnered more retweets, or used more colorful language. Love him or hate him (we love him, mostly), there’s no questioning Adam’s influence when it comes to setting the agency for J.P. Morgan online.

Of course, the J.P. Morgan meeting is so diverse that it’s impossible to capture in 10 tweets (or even 9,000, for that matter). This misses the rise of Celgene as industry bellwether, the huge amount of attention paid to obesity drugs and the increasingly important role of payers and health systems in changing behaviors within the industry. But it does give a window into what, exactly, everyone in the back of the room was doing when they pulled out their iPads.

(Also: to catch my other J.P. Morgan wrapup, check out the post on the BrewLife What’s Brewing blog.)

Today begins the annual J.P. Morgan Health Care Conference, the long-running biopharma investment confab that marks the unofficial New Year for the corporate world in biotech, pharma and medical devices. Though the meeting is officially limited to the Westin St. Francis in San Francisco, small meetings, receptions, coffees and a thousand different kind of networking spill out throughout the city.

And — increasingly — those conversations spill onto the Internet, too. A few years ago, a few hundred tweets were the norm at the meeting. This year, the conference could push the 10,000-tweet barrier. What’s interesting is not only the content of those tweets, but how the Twitter around J.P. Morgan (and its hashtag, #JPM13) are connected. After all, as the cliche goes, it’s not what you know. It’s who you know.

Last year, after the the conference ended, I published two graphs showing how online influencers connected to each other during the meeting (the “Feuericane” map that shows the impact of TheStreet’s Adam Feuerstein), and how they connected to different companies. But the folks at PureTech Ventures — the Boston-based venture group that’s behind the Appeering tweet curation tool — wanted to do one better and show those connections in real time.

Below is Appeering’s JPM Interaction Map;  a visualization that users can explore to see who is communicating — and about what — at the conference.  The map is interesting to explore on its own, but for more information, you can double-click on any node, which will bring them to Appeering conversations about that user or company. So come back often to watch how the conversation evolves.

[embedsite width=”100%” frameborder=”1″ seamless=”1″ src=””]

This map tracks the Twitter total interactions around the 2013 JP Morgan Healthcare Conference. The map is updating real-time and constantly accruing all JPM 2013 data … check back often!

Update: a full-size version of the graph is available on the Appeering  site.

For watchers of the U.S. Food and Drug Administration, the question of whether a new year will bring solid social media guidelines has become as much a part of December as peppermint bark and “Grandma Got Run Over by a Reindeer.” So will the FDA act in 2013?

In November, the answer was “yes”: “The Office of Prescription Drug Promotion (OPDP) has placed developing social media guidance at the top of its work plan for 2013, director Thomas Abrams says.” (Drug Industry Daily)

In August, the answer was also “yes”: “Social media ‘high priority’ for FDA 2012, despite lack of 2012 guidance.” (Scrip)

In June 2011, the agency said it was poised to act: “Tom Abrams, director of FDA’s Division (soon to be Office) of Drug Marketing, Advertising & Communications (DDMAC), said that publishing social media guidelines for industry is the division’s “highest priority.” (PharmaExecBlog)

The FDA said it was ready in March 2011, too: “Policy and guidance development for promotion of FDA-regulated medical products using the Internet and social media tools are among our highest priorities.” (FDA email)

And two years ago, in December 2010, guidance was imminent: “Our goal is to issue one draft guidance that addresses at least one of these topics during the first quarter of 2011.” (FDA email)

Of course, this was all kicked off in November 2009, when the agency held a two-day meeting on social media that was capped by a firm commitment to come up with rules: Social media guidelines are “important and we will do it.” Tom Abrams, Director, Division of Drug Marketing, Advertising, and Communications (FDA Public Meeting, page 450)

I don’t mention the historical record to suggest that 2013 won’t be the year where some pressing questions are answered (though the agency is working against a summer 2014 congressional deadline). Clearly, whatever the communications concerns that prompted the original FDA meeting in 2009 have only grown more clear, and some sort of action will come, either dramatically or more gradually. But, as the past few years shows, the tea leaves remain hard to read.

So what should companies be doing in the meantime? The advice remains almost unchanged from what we were suggesting two years ago: move quickly — and cautiously — to build up social media chops in corporate and unbranded spaces, improve online monitoring and work to understand and engage with the new leaders in social media. And if you need help with that? Well, we’re standing by. Drop us a line.

In March of 2007, I wrote a note to the staff here about the emergence of a new health blog that I thought had the potential to upend the health reporting world. The outlet was the WSJ Health Blog, and it promised to marry the Journal’s excellent reporting with a certain degree of take-no-prisoners snark and honesty. The Health Blog’s first writer, Jacob Goldstein, told me early on that his charge was to write “all of the things that we know as true but can’t really say in the paper.”

It was half-threat, half-promise. Jacob was cranking out a half-dozen posts on a busy day, covering the silly and the serious, and leaving no stone unturned. Outrageous executive compensation was called outrageous. Goofy television commercials were called goofy. Drug reps were compared to Faustus. And the perspective of everyone from key researchers to hospital CEOs were put on display. It was a fun read and an important read. Everyone tuned in.

That was 2007. Jacob is long gone. So is his boss, Scott Hensley (who has brought the spirit of Health Blog to NPR’s Shots blog). Over time, the blog became understaffed, and the tone had slowly morphed from a saucy, comprehensive teller of truths to a good-but-not-great source for basic consumer health news, with a handful of biopharma briefs. Yesterday, the WSJ announced that they were killing the endeavor after a 5-year-run.

The Health Blog helped create the modern health-reporting landscape, and it’s hard not to see echoes of Jacob and Scott’s original vision in Shots, in the online work that Matt Herper does at Forbes, in newspaper health blogs in places like Boston and Los Angeles. (And I was remiss in not noting Ed Silverman’s Pharmalot here in my initial draft. Pharmalot wasn’t directly influenced by Health Blog — it launched actually launched just ahead of the Health Blog in the heady late-winter of 2007 — but the competition between the two unquestionably strengthened the pharma media as a whole. Pharmalot is still going strong, a testament to the power of Ed’s years of focus.)

But good work and an impressive parent outlet is no guarantee of lasting success. The Health Blog outlasted the New York Times’ Prescriptions effort (shuttered in February) as well as health blogging efforts at USA Today.

And while we should take a moment to look back and mourn what was and could have been, there are three mammoth lessons for those of us on the marketing/communications side who are, increasingly, touting brand-created content as the Next Big Thing. But the Health Blog shows that “brand journalism” isn’t as easy as it looks. Here’s why:

  • Blogs are Beasts That Must Always Be Fed: Creating great content, day-in-and-day-out, is a tough, tough road. The Wall Street Journal is a jewel in a News Corp. empire that could hit $10 billion in profit this year. They have some of the best writers in the world. And they couldn’t prioritize the blog. Can your company do better?
  • People Matter: During salad days at the Health Blog, the blog had a definite voice and a definite perspective, thanks to Jacob and Scott. When they left, some of that voice was lost, and while the writing and reporting remained top-notch, it served as a reminder that the best social media efforts are always associated with a person (Scott Monty at Ford, Frank Eliason at Comcast, even Arianna Huffington at her eponymous news site). Will your brand journalism have a recognizable face?
  • Own a Niche: When Health Blog launched, they owned a certain topical niche: the business of health, writ large. This set them apart from what was then — and is now — the much more competitive space of examining every piece of consumer health news. But as time went on, the topics covered were less and less distinct from the offerings of a dozen other reputable sites. And while the quality was never in doubt, the lack of focus meant that there were fewer surprises. If you’re going to get in the content game, what will you be able to provide better than anyone else?

Of course, the archives of the Health Blog are still available, so take a moment today and remember. To get you started, here is the welcome post, from way back in 2007.

Pretty much since the dawn of public relations, we’ve operated on the same principle as invading aliens. We land on a particular subject, look around and say “take me to your leader.” Sometimes that is a leading advocate or a journalist with extraordinary reach or some other investor, tastemaker or celebrity. For every tribe, the reasoning goes, you can find a chief.

But the power of this approach is fading as the Internet gives rise to a new kind of group: the loosely organized, leaderless organization. The last year has been full of examples of these collectives: the vigilante hackers of Anonymous, the (more or less) spontaneous Occupy movements. But the most wonderful example is what’s happening in health care. Patients and physicians and other stakeholders are leveraging the democratic nature of the web to build true communities.

Last week, USA Today profiled a group that is making the concept a reality. A small group of women, including Jody Schoger, Alicia Staley and Dr. Deanna Attai, has organized a weekly tweetchat on breast cancer social media (known by its hashtag: #BCSM). It’s less a support group than an extended family, not just sharing advice and experiences, but the joys and sadness of everyday life. There may be no truer picture of the experience of women living with breast cancer or breast cancer survivors than what goes down each Monday night on Twitter.

And it’s not just breast cancer. The most powerful force in diabetes today may not be the well-funded organizations that have long rallied support for the disease: it’s a loose, collection of bloggers that’s known informally as the “Diabetes Online Community” (DOC, for short). No one created the DOC. No one is in charge. There’s no organization. And yet the informal network has immense power.  Ditto for doctors, too. My colleague Greg Matthews, in his rigorous evaluation of 1,400 Twitter-centric docs, found that connections between physicians is also happening outside of traditional communications channels.

But BCSM, DOC  and groups like them turn the “relations” part of “public relations” on its head. If you want to tap into that hive of information, you can’t just go to the group’s founders (though Jody, Alicia and Deanna are remarkable resources in their own right). You have to become a participant yourself. You have to watch the conversation unfold, soak in the different perspectives and understand how the fabric of the community is knit together.

Joining a community doesn’t always come naturally in communications. It requires a certain degree of vulnerability, a whole lot of transparency and the knowledge that really understanding a group requires a tremendous investment of time. That’s a high barrier to entry.

It’s a barrier that communicators will have to clear if they want to understand this new phenomenon of self-organized groups. Increasingly, top-down, bureaucracy-driven organizations are in peril, removed from grassroots supporters who no longer need a large organization to have an impact. To be sure, collectives of Twitter users won’t eliminate the need for large, groups working toward well-defined goals. But — increasingly — they’ll serve as the voice of the people. Will you be listening?