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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.

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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.

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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. 

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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. 

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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.

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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.

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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?”

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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.)

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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.

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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.

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