From Crowdsourcing to BigData - how ePatients, and their machines, are transforming health

From Crowdsourcing to BigData.How ePatients, and their machines, are evolving Health.

Aboutthe authors

Ferdinando Scala

Leandro Agrò

Ferdinando Scala is an International Digital Strategist at Razorfish Healthware, a Publicis

Healthcare Communications Group (PHCG) company. His main fields of expertise are:

Strategic Consulting, Digital Strategy, Digital Transformation, Digital Engagement, Digital

Metrics Modelling, Collaborative Media, Marketing, Communications & Change Management.

An Alumnus of the prestigious Nunziatella Military School of Naples, Italy, Ferdinando holds

an MSc in Biology (summa cum laude) at University of Naples “Federico II”, and is currently

pursuing a BSc in Communications and Media at University of Salerno.

He started his career as a researcher in the field of satellite- and airborne-based environmental

monitoring, working in collaboration with Consiglio Nazionale delle Ricerche (C.N.R.), Centre

National de la Recherche Scientifique (C.N.R.S.), Deutsches Zentrum für Luft- und Raumfahrt

(D.L.R.) and European Space Agency (E.S.A.). He successively spent 12 years in Big Pharma

companies, holding positions in Sales, Marketing and Commercial Operations at both national

and international levels.

A passionate Wikipedia author (16.000+ contributions), on June 2011 he was shortlisted

for becoming a member of the Board of Trustees of the Wikimedia Foundation (WMF) and

on February 2013 he became a member of the global Elections Board. He was finally the

Candidacy Leader for the City of Naples, Italy, to be the hosting town for Wikimania 2013, the

global conference of Wikimedia Foundation.

Leandro Agrò is the Principal Experience Architect at Razorfish Healthware, a Publicis

Healthcare Communications Group (PHCG) company. His main fields of expertise are:

Service Design, User Experience, Interaction Design and Digital Strategy. As visiting Professor

at Siena University and Producer of Frontiers of Interaction Conference, Leandro has also been

awarded by Venice Biennale of Architecture, ADI Index, TechGarage, New York Times, Wired,

WebAward, and other International Institutions.

Leandro’s education originates from the Italian design culture. He completed a post graduate

degree in Interaction Design at Domus Academy (Milan, Italy), winning the Interaction Design

competition at Apple Computer, Cupertino, CA in 1997. As blogger and writer, Leandro

published more than 300 articles mostly focused on the consequences of technology and

innovation; he contributed to four books has spoken at TEDx, World Usability Day, UXCON,

eTech, World Business Forum and BayCHI (ACM).

In the last 15 years, Leandro designed the first UMTS/3G user interface ever developed; He

contributed to patents in the photo-video field; and designed the first multimodal computer UI

based on eye-gaze (patented) used in the healthcare field.

@fscalapro

@leeander

ferdinando.scala.phi

leeander

Linkedin.com/in/ferdinandoscala

Linkedin.com/in/leeander

Introduction

This whitepaper exposes today’s most relevant patient and healthcare data

trends for the benefit of health marketers, and how they will impact the

healthcare value chain.

Today oceans of data are being produced and collected both by people and

machines, at the same time changing the way we think about healthcare as

a field of study; as a result Patients - actually ePatients - are becoming ever

more informed and independent with their healthcare decisions.

This “perfect storm” in the making, revolving around new paradigms of

“Crowdsourcing” and “Big Data”, will radically change the current healthcare

Industry and reality of marketers. The mode in which drugs and healthcare

delivery are to be presented to healthcare professionals, patients and other

stakeholders is increasingly important in this new data driven paradigm. As a

marketer, are you ready to embrace this change?

4Razorfish | Healthware From Crowdsourcing to BigData June 2013

As the seminal bookBlue Ocean Strategyby W. Chan Kim and René Mauborgne......demonstrated in 2005, real progress for a company does not lie in fighting for space in already crowded markets.

Instead, the creation of new operative space, where to operate alone, otherwise known as “blue oceans”, is the sole

viable option for building a consistent and durable strategic advantage.

While being highly rewarding when a company manages to find them, “blue oceans” are not easy to spot or build.

Basically, building a durable strategic advantage requires one to identify and put in relation concepts and resources

that are apparently unrelated. Normally, companies are not good at spotting new opportunities, since their operational

model is built to robustly guarantee excellence in delivering effectiveness around the available products and

services. The convergence of apparently unrelated concepts is in fact determining a quantum leap in the healthcare

environment, and only the companies that are prepared to ride the wave will succeed in the next years.

In the following paragraphs, we will show you how a monkey, a typewriter, the largest global encyclopaedia, your

smartphone and your health records are all related; and will shape the future of the healthcare industry.

4 5Razorfish | Healthware From Crowdsourcing to BigData June 2013


01


KNOWLEDGE IN THE AGE OF INTERNET

Author: Leandro Agrò

Nearly every possible question has

an answer to be found somewhere

on the Net. This is valid if you are

searching for a theory, a point

of view, or relevant data and

information. This statement, as

extreme as it might seem, is true

irrespective to whether you are

looking for the manual for your

washing machine, or want to build a

space rocket – or Satellite - in your

own back yard!

Maybe building a satellite in the

garage is not the most practical

thing to do, but the fact that it is

possible shows that the knowledge

available to everyone on the

Internet even makes an apparently

impossible task, such as space

exploration, available to the masses.

The same depth of information is

not limited to space exploration, but

could empower individuals in their

knowledge of other uncommon

subjects such as Physics. For

example, Prof. Walter Lewin, from

Boston’s MIT Open Courseware,

is one of the best professors of

physics on the planet – and his

knowledge and highly entertaining

lectures are available to everyone for

free on the Net.

In summary, the Net today is the

repository of the best information

ever expressed by humanity in

virtually every area of knowledge

and industry; and this knowledge

is growing in organized hubs. For

example, TED conference (TED.com)

is a major destination of high-level

knowledge available to the public.

Importantly, TED is delivered in a

lecture/audience format accessible

via video. This leading conference

also has a version called TED

MED, specifically focused around

healthcare (http://www.tedmed.

com/videos).

Prestigious universities, conferences

that generate knowledge useful

to the future, new generation

institutions like the Singularity

University (SU), as well as individual

investigators who have an open-

source mind set and raise revenue

by means of crowd funding, all

have one thing in common: they

are collaboratively building and

disseminating their knowledge for

free on the Net. In this respect,

SU is one of the most important

examples of how this can happen.

As an institution whose mission

is “to assemble, educate and

Knowledge repositories: TED,

amongst others

We can hope that “soon” (in a few decades), we will reach the tipping point

that will allow for accurate automated translations, for now we must make

use of the only intelligence adequate for this task: multilingual human

beings.

Crowdsourcing is becoming the way to handle accurate and contextual

multiple language translation.

Places like TED.com or VIDEUM.com (a video portal dedicated to

healthcare) are leveraging crowdsourcing to -potentially- translate and

“language enable” all content for the benefit of users around the world.

The Language Issue


Traditional knowledge building

models are linked to the linear model

of thought. The organization of

concepts into a coherent significant

unit, like a speech, an article or a

book, always requires the author(s)

to plan in advance a logical structure

composed by “buckets”, like issues

to be addressed or chapters. These

“buckets” had to be organized in

a linear concatenation, so that the

reader could easily follow the train

of thought of the author(s). More

importantly, this kind of process

was considered as the only one to

efficiently deliver coherent results.

Linear knowledge building models

have been put in discussion when

first confronted with the theoretic

possibility to have infinite time

and resources to build a logical

sequence of concepts. A well-

known exemplification of this

theory is the so-called “infinite

monkey theorem”. According to

WHAT IS CROWDSOURCING

inspire a new generation of leaders

who strive to understand and

utilize exponentially advancing

technologies to address humanity’s

grand challenges”, SU uses the

collaborative strength of its students,

some of the most brilliant minds

in the world, to tackle and solve

problems which are out and beyond

their normal field of competence.

The reasons behind the success

of collaborative phenomenon are

complex, and they are eloquently

explained in Dan Pink’s TED lecture:

The puzzle of motivation: (http://

www.ted.com/talks/dan_pink_on_

motivation.html)

In order to understand how the

collaborative building of knowledge

is realized, and what implications

it has for the information diffusion

in general, and for the healthcare

field in particular, we need to

delve deeper in the world of

crowdsourcing and collaborative

communities and projects.

Career analyst Dan Pink examines the puzzle of motivation, starting with a fact that social

scientists know but most managers don’t: Traditional rewards aren’t always as effective

as we think

The infinite monkey theoremAuthor: Ferdinando Scala


this theorem, if a monkey (therefore

a being not provided with human

logic or sense of purpose) had a

typewriter and infinite time at its

disposition, it would be able to build

up the complete works of William

Shakespeare by sheer brute force,

by randomly tapping on the keys.

Even if this theorem has some

strong limitations, it is very important

from the conceptual standpoint. It

conveys the idea according to which

even in apparently unfavourable

conditions (non-human being,

random actions, lack of sense of

purpose), by having infinite time and

resources available, any knowledge-

building task is possible.

Things consistently change when

experimental conditions change.

When we have at our disposal

sentient and self-aware human

beings, who perform voluntary

actions, which are driven by a

sense of purpose, the time to build

a knowledge artefact consistently

reduces, in exponential relation

to the number of individuals or

resources available, even in the

absence of a formal scope or

organization.

The conditions mentioned above are

at the base of the crowdsourcing

concept, which first appeared

in 2006 in a seminal article by

Jeff Howe in “Wired” magazine.

TechnologyTrigger

Plateau ofProductivitySlope of Enlightenment

Trough ofDisillusionment

Peak of In�atedExpectations

EXPECTATIONS

TIME

Automatic Content

3D Scanners

Internet of ThingsNatural Language Q&A

Speech-to-Speech Translation

CrowdsourcingBigData

Gami�cationHTML5

Wireless Power

3D PrintingBYOD

Social AnalyticsPrivate Cloud Computing

Application StoresAugmented Reality

In-Memory DB Management

NFC Payment

Cloud Computing

Mesh Networks

Gesture Control

In-Memory Analytics

Text Analytics

Home Health Monitoring

Virtual Worlds

Mobile OTA Payment

Media TabletsConsumerization

Speech RecognitionPredictive Analytics

Biometric Authentication Methods

Audio Mining Speech Analysis

Autonomous Vehicles

Holographic Display

Recognition

3D Bioprinting

Quantum Computing

Human Augmentation

Adapted from Gartner HypeCycle

Plateau will be reached in: Less than 10 years More than 10 years

CROWDSOURCING HYPE

Positioned in the Gartner Hype Cycle 2012http://en.wikipedia.org/wiki/Hype_cycle before the “Peak of Expectations” Crowdsourcing is still the “new thing”. The opportunities to leverage this technology and approach are in front of us, and the knowledge we have infused in the Net is too much to be handled.


The author presented for the first

time the possibilities offered by

the unstructured, collaborative

approach for business purposes.

Since then, the meaning expanded

to a significance that here we define

as:

Since this publication, the concept

has exploded in a series of

applications outside the business

world, of which Wikipedia is the

most well-known example.

Wikipedia is probably the best-

known example of crowdsourcing

applied to knowledge building at a

worldwide and cross-cultural level.

Built from the collaborative effort

of anonymous contributors, each

adding up a piece of information,

revising grammar and formatting

pages, Wikipedia is as of now

the most complete repository of

human knowledge. One of the

Top-5 ranked websites in the world,

and consistently in first position in

Google search pages, Wikipedia

contains 23 million articles, has

about 100 000 active contributors

and it is edited in 285 languages.

In 2012, it received 2.7 billion page

views per month from the United

States alone.

Also when examined in terms

of quality of content, Wikipedia

shows good consistency and

credibility, despite it being the

result of unstructured work. In a

renowned 2005 article in Nature,

Jim Giles argued that, for some

scientific areas, individual Wikipedia

articles had the same rate of errors

that a review of the homologous

article on Encyclopaedia Britannica

(EB) could put in evidence. Even

though the article was disputed

by EB, eliciting a successive

rebuttal by Nature, it remains

evident that individuals, simply

driven by their will to contribute,

and working in an unstructured

way, can collaboratively achieve

results which normally implied

the construction of a structured

expert panel, and the investment of

physical and economic resources.

More importantly, it demonstrated

the feasibility of an apparently

daunting scope: gathering all human

knowledge in a single place, in

any possible language, and freely

available to everyone.

While still probably surpassing

The total encyclopaedia:

Wikipedia

“The use of crowd, without

any formal or hierarchical

coordination structure

among its members, for

performing a certain

scope, in order to pursue

which, an exceptional

amount of resources would

be necessary; where

“exceptional amount

of resources” means a

quantity of time, money,

personnel or skill, and their

combinations, which would

exceed the capabilities of

any formal organization.”

Author: Ferdinando Scala


Wikipedia articles in terms of

overall content quality, EB fails in a

fundamental aspect of knowledge

diffusion, i.e. the availability of its

contents in any possible language

worldwide. Furthermore, even if EB

would set itself to this scope, the

amount of personnel, skills, and

monetary resources especially,

would be prohibitive - and would

doom the project to failure.

In summary, from the Wikipedia

vs. EB example, we can derive a

general theorem, which proves

itself as correct when the following

conditions are respected:

We have examined how

crowdsourcing generates huge

quantities of organized data by

means of the non-coordinated effort

of unrelated contributors. Even if

there is no hierarchical relationship

among contributors, the creation

of these huge knowledge buckets

is still strictly related to individual

human skill and willingness.

Once we understand the basic

concepts of crowdsourcing, we are

ready to revert the infinite monkey

theorem, and bring our analysis on

a further level. The next questions to

be considered are:

a. What happens when data generators are potentially infinite in terms of the number and quantity of parameters they take into account?

b. What completely new possibilities are available when data generators are networked into a system running under a set of cybernetic rules, which ensure constancy, reproducibility and analytical accuracy of measured phenomena?

The answers to these questions are

found when examining the world of

Big Data, the concept of Quantified

Self and their consequences for the

healthcare domain.

Today: All places that are

mono-cultural or with a single

sender that operates in logical

broadcast, make it increasingly

difficult to gain trust. Also, on the

other hand, it is difficult today

that a “pyramid” not sufficiently

open - as is typical of crowd-

mechanisms - can find the

necessary trust.

Pyramids – as well as YouTube

- were built by many. Stories,

information or generally speaking,

“content” define who we are and

what we are able to do. While the

old giants –like Encyclopaedia

Britannica that are not available

in a print version anymore- are

silently passing in time, all the

new mega-content-structure

emerges on the Web, shaped in

ourselves in near real time.

The CredibilityIssue

“Given a collaborative

knowledge-building task of

any dimension, the quantity

of time and monetary

resources necessary for

completion is inversely

proportional to the number

of contributors and their

individual specific skills

level; while the quality of

final outcome is directly

proportional to this number

and skills set.”


WHAT ARE BIG DATA?

As the renowned physicist Lord

Kelvin (1824 - 1907) proclaimed, “If

you cannot measure it, you cannot

improve it”. This law was designed

by humans to meet the needs of

science, which were becoming

more complex. Over a century later,

we continue to find this complexity

in every moment of our working

lives. Measuring everything has

become a “human centric” issue

– about knowledge and control

in the Internet Age - exactly when

technology was able to fill it. But

more importantly, measurement has

emerged as a social need today

because we are living in real time in

the digital sphere. …and this WAS

just the beginning of an incredible

emergent trend: In the Internet

Age, or better yet, in the upcoming

Internet of Things Age, we do not

have enough humans to take care

of all sensors, devices, satellites,

and –in general- infrastructures that

we create. Measuring everything is

an intrinsic need of the technology

we are leveraging to build our world.

And actually it is also a need of the

world itself, as a planet, to face the

impetuous evolution of the human

footprint. Measuring everything has

already changed other industries –

and healthcare is not immune.

Patients are the biggest community

in healthcare and - today - thanks to

all their portable smart technologies,

they are becoming an active actor

in health, nutrition and wellness

data collection. The diffusion of

these technologies is becoming so

widespread, sensible in terms of

measured parameters, and easy to

carry for people, that it is opening a

brand-new opportunity, called the

Quantified Self (QS) movement.

The QS approach is to incorporate

technology into data acquisition on

most aspects of a person’s daily

life in terms of inputs (e.g. food

consumed, quality of surrounding

air), states (e.g. mood, arousal

and blood oxygen levels), and

performance (mental and physical).

The primary methodology of self-

quantification is data collection,

followed by visualization, cross-

referencing and the discovery of

correlations.

This powerful trend has inspired

numerous hardware devices

(mostly in the wellness area) that

leverage components for cost

reductions in sensor technology,

mobile connectivity, and battery

life, and that have already become

part of the everyday life of millions

of users. This trend resulted in the

appearing and explosive expansion

of products like Withings, Nike+,

fitbit, as well as software apps for

smartphones used to track almost

every aspect of life.

Behind the QS, there is an emerging

desire for an individual to improve

oneself, and a natural human

Measure Everything: If you cannot measure it,

you cannot improve it

Data sources: the Quantified Self




Data sources: crowdsourcing for men

and machines

tendency towards competition within

one’s own microcosm (friends &

followers).

The QS is also related to the

philosophy of interdependence,

donating information about oneself

to be used as a contribution towards

new knowledge about people’s

behaviour and habits as well as the

discovery of new medical cures.

From the Pharma perspective,

QS is creating an emerging and

immediately relevant group of

stakeholders. Right now, most of

the work of data collection and

publication is made manually, while

every day more and more devices

become autonomous.

Using pen and paper, people are

already able to collect and share

tons of useful data. Using shared

tools such as Wikipedia –or any

other collaborative tools on the

Web- people are able to conceive

and evolve spaces of sense and

culture.

Powered by sensors – ever more

present in many devices – and

thanks to cloud computing – a

remote service that collects and

crunches the data – people are

re-writing their own knowledge

and, with it, a perception of today’s

reality.

The Net is both for humans and

machines, and today we should

bear in mind that machines are

more numerous than their human

counterparts. The evolution

of human crowdsourcing and

participation is a mixed human/

machine crowdsourcing and

interaction.

In the field of health, “we can benefit

from the multiple data types coming

on-stream at the same time. These

include electronic medical records,

inexpensive gene sequencing,

personal sensor data, qualitative

contributions by self-tracking, and

more”. (Cit. When Data Disrupts

healthcare http://www.youtube.com/

watch?v=IAt0jw306fk).

We need to talk with people, as well

as integrate in the “discussions” they

have with their machines.

This approach takes us to Big

Data, and unleashes the potential

of analysing information on a

worldwide scale for almost every

possible topic or matter.

The availability of different datasets

presents an opportunity for “High

Tech Companies” because data

scientists and technologists

already have the skills to manage

the data. We have already done


The day in which we will

produce more content in a

single day, than the rest of

human history, is near at

hand.

However, currently the

amount of data produced by

humans is very much less

than the data produced by

machines.


something similar in the financial

field. Today, almost completely

driven by machines based on Big

Data analysis, relevant results can

be found correlating the many

healthcare data sources.

Up to this moment, we established

the basic concepts of crowdsourcing,

Big Data and Quantified Self, and

we could be tempted to consider

them as distinct and far away from

daily reality. Quite the opposite,

these technologies and trends are

already impacting the pharmaceutical

industry. In the following

paragraph, we will understand how

crowdsourcing is impacting R&D.

The traditional model for R&D

development in any company has

always been based on the selection,

hiring, and consolidation of the

best talent, to produce innovation

transfered into sellable products for

the market. This kind of process

has the advantage of ensuring

consistency and continuity of effort

toward a certain objective, which

functions well when the amplitude

of challenges is consistent with the

dimension of the R&D structure.

As a downside, having a

consolidated R&D structure implies:

a) Consistent organizational effort

in order to select, maintain, and

manage the right people in the right

place: with huge expenses in terms

of HR resources;

b) Limited ability and capability

to address prevalent scientific

problems; delimited by the individual

and collective skills of the R&D team

members; and the sheer number of

people, time and resources on hand.

As a consequence, when an R&D

challenge exceeding the talent

pool or organizational resources

capabilities arises, the development

process can come to a halt, with

huge consequences in terms of

overall financial and operational

capability of the company.

Crowdsourcing is a way of expanding

the available pool of talent, and

even gaining insights that would not

have been generated, due to the

structured development processes

inherent to a corporate structure.

Based on this concept, in 1998,

some Eli Lilly executives generated

the idea at the base of InnoCentive,

a crowdsourcing platform whose

initial field of application was

pharmaceutical R&D, but today

extends its business model in other

areas like engineering, computer

science, mathematics, chemistry,

life sciences, physical sciences and

business. The InnoCentive business

model is based on the online sharing

of pharmacological or clinical

development problems, for which

it is unpractical to find a solution

internally, and the call for proposals

to platform members. InnoCentive’s

members have thus the possibility

to contribute to the resolution

of proposed problems, earning

consultancy fees for their contribution

ranging from 500 to 1.000.000 USD.

The model has encountered

considerable success, to the point

that today prominent organizations

InnoCentive: a case study in crowdsourcing

for pharmaAuthor: Ferdinando Scala


in a wide array of business sectors

like BAE Systems (avionics),

Booz|Allen|Hamilton (consultancy),

The Economist and Nature (editors),

Hershey’s (food), Hewlett-Packard

(computers), Eli Lilly and Roche

(pharmaceuticals), NASA (space

exploration), PepsiCo (beverage)

and Procter&Gamble (Fast Moving

Consumer Goods) are currently

partnering with InnoCentive in

order to solve their problems. The

InnoCentive community includes

about 200.000 individuals from more

than 170 countries. As of now, it has

distributed fees for an overall amount

of 28.000.000 million USD.

All healthcare market players have

one very relevant thing in common:

they produce data. The whole of

healthcare is becoming an industry

based on Big Data.

Could this high-end technology be

an entry barrier in the healthcare

space?

No. Dozens of companies are

already competing in the massive

data collection arena, fighting to

offer qualified – low cost – analytic

tools.

Kaggle – based in California - is

a good example. Financed with

11.000.000 USD, Kaggle launched a

platform for predictive modelling and

analytics competitions. Companies

and researchers post their data, and

statisticians and data miners from all

over the world compete to produce

the best models.

As an example of an advanced

healthcare company, Boehringer

Ingelheim (BI) is actively engaged in

this platform to further its business.

Predictive “in silico” modeling of

biological endpoints is an important

and useful component of the drug

discovery process. To investigate

potential genotoxicity liabilities

in small molecule candidates,

the BI research team launched

a competition using Kaggle. The

BI team expected to realize the

following benefits:

• Competitive advantage in time and cost efficiency

• Engagement with an external community of data scientists to create an awareness around BI as a cutting edge, innovative organization

• Reactivity: to almost immediately deploy the winning model(s) internally for use by medicinal chemists through Bipredict, or other local distribution platforms

The competition was launched

on 16 March 2012. As early as

22 March there were 74 teams

(comprised of 90 players) who had

submitted 277 entries. 24 of these

entries represented models that

were ‘better’ (i.e. more predictive)

than the best initial benchmark.

The success of this project has

been covered in a BI press release,

and received subsequent coverage

in several blogs. Moreover, tweets

from both @boehringer and

@boehringerUS have garnered

>200K impressions to date.

Kaggle Data Science Competition: a BI case

study in crowdsourcing



02

“

”

Crowdsourcing, Big Data, and Quantified Self are important trends revolutionizing the development of new drugs and connecting inherently limited frameworks, like clinical studies.

The impact of these trends, however, is not limited solely to the domain of clinical research; they are also readjusting the way corporations communicate to their external audiences.

In the following section, it will become apparent how traditional, linear communication models are being substituted by completely new ones. The result of this process is a brand-new marketing and sales paradigm, which requires pharma executives to readjust their cultural and operational models.


COMMUNICATION MODELS

The communication process is

traditionally defined as the passage

of informational units (content),

coded into some sensorial artefact

(language) from an entity which

produces them (emitter) to another

entity with receives them (receiver).

Context and channel employed in

passing the informational units from

one entity or the other are pivotal in

determining the quantity of delivered

information and its interpretation.

When described as such, it is

evident that communication

has historically been interpreted

as a linear process, in which

informational flow travels in one

direction, and no feedback is

considered. This philosophical

attitude was the cultural substrate

to the construction of the mass

communication system, whose

media (newspapers, radio and

television) acted as unidirectional

channels for message delivery from

emitters to target users. The result

of this model was that the owner(s)

of media channels were also the

owners of information. Media

owners were indeed in a position

to determine the agenda, i.e. the

type, combination and frequency of

information which, when delivered

from emitters to receivers, massively

contributed to build the audience’s

knowledge, attitude and opinions

about whatever issue the agenda

setters felt functional to their own

needs. In addition, agenda setters

also had the possibility to determine

not only which information had to

flow from emitters to receivers, but

also which information should not be

delivered.

Traditional advertising models also

conformed to this hierarchical logic,

in which there is a linear and non-

equal relationship between the

emitter and the receiver, where the

latter is passive in terms of acquiring

information. Traditional advertising

is based mainly on the attraction

of target users in predetermined

channels; the offering of valuable

content to them; and the application

of the so-called contextual (printed

paper) or interruption marketing

(radio and television). In this

respect, the main strategy used by

advertisers to ensure their content

was received was the saturation of

physical (tabular advertising) and/

or media (press/radio/television)

space. This is so the end user had

a higher possibility of encountering

the message throughout the day.

In parallel, within a specific medium

(like television), the most successful

brands were the ones having the

possibility to win the competition

for the most fruitful time slots (prime

time), i.e. the moment of the day when

most users were connected to that

medium/channel. Finally, persistence

of the message, and therefore the

realization of sales, depended on the

single campaign extended over time,

and frequency of message repetition

Hierarchical models and broadcasting

Author: Ferdinando Scala


within a single day.

While functioning well for many

decades, and allowing the surge

and fortune of a whole industry

based on traditional media, this

mechanism has proved to be

progressively less efficient over

the last few years. In particular,

television has suffered an extensive

loss of efficacy in terms of public

adherence, principally owing to

an increase in the frequency of

interruption marketing practices.

The introduction of technologies like

remote control and TIVO strongly

empowered users against the

mounting wave of advertising slots,

and their excessive frequency in the

body of programs. Furthermore,

while remaining of interest to the

generations who were involved in

this system of content broadcasting,

television has progressively lost

its power as a medium, especially

for the younger generations, those

who first embraced the digital

media revolution and its mobile

development.

This resulted in the declining

efficacy of television as a means of

sales generation for Fast Moving

Consumer Goods (FMCG), and in

the pharmaceutical field for Over

The Counter (OTC) drugs. While

commercial and pharmaceutical

industries began to realize this fact,

an increasing amount of investment

was progressively diverted from

traditional media to the new digital

channels.

The traditional sales force could

be seen as the prescription drug

equivalent of broadcast media; with

a large number of representatives

using the same materials and

delivering the same message to

their customers. Pharmaceutical

companies have already been

steadily moving from this traditional

model by using customer profiling

to tailor messages and interactions.

This is becoming ever easier

to manage given the variety of

digital channels now available to

physicians.

These past few years have been

a testimony to the strength of

the digital revolution, with the

progressive introduction of

technological assets and tools

having fundamentally changed the

communication panorama. The

building of the World Wide Web and

its mobile development generated a

completely new system of relations

and communicational fluxes,

identified as a “network model”

The network model disrupts the

traditional, hierarchical models, by

breaking the linear and non-equal

relationships between emitter and

receiver. The receiver becomes

an information selector and an

emitter, whose influence and impact

depend on the extent and depth

of their social network. The rate

of disruption is so deep that the

lexicon has changed, generating

the neologism “prosumer”, to

define a new type of actor. The

term “prosumer” results from the

merging of the words “producer”

and “consumer”. In the specific

informational domain, it has the

significance of a “person who is

The network model and P2P Author: Ferdinando Scala


simultaneously a producer and a

consumer of information”. People

previously known as “target” or

“audience” have been enabled

through the construction of

networking infrastructures and tools

(social networks like Facebook or

LinkedIn; collaborative media like

Wikipedia) to exit the traditional

paradigm. Where they were

formerly absorbing information

from hierarchical, unidirectional

media, they are now information

emitters with their closely related

peers. It should be recognized

that information exchange among

peers existed prior to the creation

of social networks. Indeed, a large

part of the traditional advertising

model was primarly based on

influencing the so-called “opinion

leaders”, i.e., individuals who had,

because of their standing and

measure of influence, the capability

to spread, by affixing in the minds

of others, messages coming

from the interested emitters. The

pharmaceutical world has always

relied on this paradigm, e.g. passing

information about new drugs,

new indications and new clinical

studies, to prominent physicians

(Key Opinion Leaders - KOLs).

These KOLs assumed the role of

interpreters of the pharmaceutical

industry’s data and messaging

towards the medical community.

What has changed forever with

this advent of Internet and social

networks is the sheer number of

people simultaneously reached by

a discussion about a topic, has

changed from a few (let’s say the

direct colleagues of a GP or the

peer Specialists in a Hospital, and

generally limited to the immediate

geographical surrounding); to many

hundreds (in relation to the extent

of the virtual network a single

individual has, and irrespective of

the geographical dimension).

In this context, while still maintaining

a strong measure of influence, the

opinion of Key Opinion Leaders is

somewhat blunted and diluted by

the possibility that other subjects

(prosumers) actively select and

spread information, according to

their own rules and beliefs. Under

these circumstances, the personal

relationships among peers (where

“personal” does not necessarily

imply a direct connection in the

physical world; and is measured

on the frequency and quality of

interactions) are based on trust and

credibility.

It is therefore important to

understand the new rules which

apply to the new channels, which

are much more volatile and

immaterial than before.

We shouldn’t consider this evolved

marketing scenario -where peers

need to be frequently reached

with coherent messages- just as a

fragmented target to address with

a common message. Empowered

HCP and Patients are walking away

from any kind of broadcast. Today

the most efficient way to reach them

is joining (or leading) the so-called

“Conversation”.

As a quick background about the

Real time is for marketing (the Cluetrain manifesto)Author: Leandro Agrò


idea of “conversation”, we should

start from the seminal book “The

Clue Train Manifesto” (also known as

CTM, 1999).

The Clue Train Manifesto contains

95 theses that re-defined Online

Markets and re-shaped marketers

culture.

During these years, powered by

the digital change, networked

markets self-organize faster than the

companies that have traditionally

served them. Thanks to the Web,

markets become better informed,

smarter, and more demanding of

qualities. In this new scenario –as

declared by the first thesis of the

Clue Train Manifesto: markets are

conversations.

What does it mean when one says,

“markets are conversations”?

Authors assert that people

leverage the “human-to-human”

conversations with companies,

which potentially transform

traditional business practices

radically in today’s reality.

Conversation is the CTM key

concept: According to the second

and third thesis reported in the

book, “Markets consist of human

beings, not demographic sectors”

and “Conversations among human

beings sound human. They are

conducted in a human voice”.

These few theses are enough to

radically shift what most companies

are doing in their communication

plane, both in the physical and

digital spheres. The consequence is

the communication of a totally new

value chain, because “Hyperlinks

subvert hierarchy” and people –

through the Internet - no longer

depend on traditional knowledge

and information sources.


INTRODUCING THE ePATIENT

In a world where a global conversation

is evolving the whole healthcare

market, people use the Internet to find

tons of information about any disease,

and to potentially contact anyone to

collect different opinions.

The power of information-access

in the hands of any single person

today, is bigger than the one

available to US President 20 years

diseases to which we are vulnerable.

In just two hundred years we have

gone from a society suspicious of

science, to one centred around

science.

Today we live in a world where

private companies such as SPACEX

launch into the orbit rockets and

satellites and where ten percent

of the gross domestic product of

the world’s major economies is

spent on health. In the world of

pharmaceutical companies, we

find examples such as Johnson

& Johnson (the largest of all Big

Pharma), which is at 40th position

of the Fortune 500 ranking. The

size of this company is based on its

120.000 direct employees and over

$60 billion in sales. In comparison,

Apple, with its $65 billion and half of

the employees of J&J, is just above

at 35th position of Fortune 500

(2012 pre-iPhone5 rankings).

ago. Today we have the “big picture”

of healthcare at our fingertips. For

example, today we know that there

has never been a time in the past

when humanity was better off in

terms of wealth and health than

it is today. The video “The Joy of

Stats: 200 Countries, 200 Years,

4 Minutes” by Hans Rosling (BBC

Four) could suffice to inspire this

systemic optimism.

This depends on many factors,

including what we know today about

our health and how to treat


“The Joy of Stats”

This video illustrates how over the past two centuries, life expectancy and per capita wealth, have vastly improved for many nations. Of course the current state of health does not mean that there are no other potential alarms for the planet, BUT if you look at our health, we cannot miss the underlying declaration of this video that WE ARE GOOD and have NEVER BEEN BETTER.

http://www.youtube.com/watch?v=jbkSRLYSojo


The comparison - even that of

wealth – between the consumer-

oriented Apple, and J&J or any other

pharmaceutical company, might

seem completely out of place, and

actually, for a long time, it was.

In recent years, however, the

mutation of both economic and

cultural dynamics has made

comparisons of companies like

these more justified. The need to

be more efficient and closer to

the end customer, even in health

organizations, is changing from

within.

The digital culture that permeates

society has changed the needs

and expectations of customers,

forcing entire industries to convert

mentalities, or come to terms with

the traumatic entry of outsiders, who

have already done so. Regardless of

your opinion of the Mayan prophesy

announcing the end of the World

by 21 December 2012, that was the

year in which some major players in

the healthcare world went through

their “perfect storm.”

2012 has indeed been labelled

‘annus horribilis’ due to the number

of healthcare patents that are

approaching expiry. By 2015,

following the expiry of very relevant

patents, the ranking of the 50 largest

pharmaceuticals may undergo

drastic changes or even some

surprising extinctions. This crisis has

forced many companies to return to

heavy investment in R&D. By nature,

this contemporary approach often

translates into research in the field

of biotech. As a result, the culture of

many companies is moving from a

“cure-all drug” to a “drug tailor-made

for you.”

A key point of this cultural shift is the

change in the almost total access to

the medical information base. At the

same instant in which a disease -

especially if not particularly severe -

affects us, we become transformed

not into “sick people” but into

ePatients: people who are able,

through the distributed knowledge in

the Internet network, to learn about

their conditions as well as treatment

options, comparing the different

therapeutic approaches and results.

However, one needs to be careful

and not consider the ePatient as a

consequence of technology or an

outcome of the Facebook era.

Dave deBronkart coined the

definition of ePatient, made

famous with his speech at the TED

Conference, when he narrated this

episode:

“That Fall of 1969, the Whole Earth

Catalog came out. [...] We think of

hippies of being just hedonists, but

there’s a very strong component

-- I was in that movement -- a

very strong component of being

responsible for yourself. This book’s

(the Whole Earth Catalog) subtitle

Healthcare is moving out

of its “Ford” era just as the

culture of the Internet is

growing evermore rampant,

and this mix is potentially

disruptive.


is: “Access to Tools.”[...] Tom

Ferguson was the medical editor of

the Whole Earth Catalog. And he

saw that the great majority of what

we do in medicine and healthcare

is taking care of ourselves. In fact,

he said it was 70-80% of how we

actually take care of our bodies. Well

he also saw that when healthcare

turns to medical care because of

a more serious disease, the key

thing that holds us back is access

to information. And when the

Web came along, that changed

everything, because not only could

we find information, we could find

other people like ourselves who

could gather, who could bring us

information. He coined this term

e-Patients - equipped, engaged,

empowered, enabled.”

This hippie counterculture note

helps emphasize how seeing the

ePatient as an insignificant role

would be a double faux pas. Firstly,

since it is an ingrained, long-

established phenomenon. And

secondly because phenomena that

benefit from digital advancement

are rapidly approaching their tipping

point: http://en.wikipedia.org/wiki/

The_Tipping_Point.

ePatients are motivated and

prepared to do everything it takes

to help save their own lives, and

looking at the opportunities that

this change has created, you

could say this democratization and

consumerisation of healthcare is not

necessarily a bad thing.

ePatients are not the only forces

that are influencing the world of

healthcare. The entire industry is

affected by new situations. Recently,

in The NewYorker, an article was

published with this provocative title:

“Restaurant chains have managed to

combine quality control, cost control,

and innovation. Can healthcare?”

The thesis of this article is

summarized as follows: The

Cheesecake Factory, used as an

example, is part of the casual dining

industry and, present everywhere in

the United States, can serve fresh

food, cooked on the spot, with a

growing price/quality ratio to eight

million people each year. In attaining

this result, they have democratized

access to certain foods for lower

income groups, and at the same

time, they had to influence the

processes of supply logistics and

their suppliers, optimizing logistics

and processes both internal and

external.

This action, which affects the source,

is of course only possible when you

reach a certain critical mass. The

process of improving the quality/cost

ratio of the entire sector of casual

dining, started when the chains

became protagonists. Now, this

very same change is happening in

healthcare.

“Medicine, though, had held out

against the trend. Physicians were

always predominantly self-employed,

working alone or in small private-

practice groups. American hospitals

tended to be community-based.

But that’s changing. Hospitals and

clinics have been forming into large

conglomerates.

According to the Bureau of Labor


Statistics, only a quarter of doctors

are self-employed—an extraordinary

turnabout from a decade ago,

when a majority were independent.

They’ve decided to become

employees, and health systems

have become chains. In medicine,

we are trying to deliver a range

of services to millions of people

at a reasonable cost and with a

consistent level of quality. Unlike the

Cheesecake Factory, we haven’t

(yet) figured out how.”

Similar examples can be drawn in

many areas across the world of

healthcare. Even the area of medical

devices is not without drastic

changes. Just going to the Apple

Store, one can find many medical

devices that cost less than a

hundred dollars. Just five years ago,

we could only find these devices in

a pharmacy and we would only have

purchased them on medical advice.

One example? Withings Blood

Pressure Monitor, for an easy and

accurate self-measurement of your

blood pressure directly on your

iPhone. http://www.withings.com/

en/bloodpressuremonitor.

From ePatients to the influences of

changing forces across the value

chain, the world of healthcare is

rapidly changing. A key player in

this change is that of technological

acceleration. When digitalization

affects one industry, it does not

leave it immune to its actors, or

better yet, pulverized and in many

ways expands the supply chain,

requiring all existing actors to

deal with change and possibly

predisposes it to new opportunities.

Healthcare is not free from this

explosive effect of digital and

ePatients represent the most visible

part of this rapid change.

ePatients are not special people. We

are ePatients when we:

• Seek information on the Internet about symptoms or diseases

• Seek practical advice via social networks and share experiences related to health

• Use self-tracking or wellness devices because we aspire to feel better

• Think of a hospital as a service company

• Look at the tools that doctors use and compare them with the technologies that we have in-house

• Look at drugs no longer as closed boxes accessible only by doctors, but as products we use and to which we subject to careful scrutiny before purchase

• We influence those around us by sharing our experiences on health

An article published on January

16, 2012 by TechCrunch “PEW

Research was reporting that 17

percent of mobile phone users

were using their devices to look up

health and medical information, and

Juniper recently estimated 44 million

health apps were downloaded in

2011.”

In 2011, in terms of earnings, the

area of mobile health applications

reached $ 718 MM. The main

reason for the significant growth is

an increase of smartphone users on

the demand side, and the increase


of mobile health applications on the

supply side that has doubled since

2010.

Many major healthcare companies

have found mobile health

applications as being an effective

medium to promote and deliver

healthcare products and services.

More information on the mobile

health application market can be

found in the detailed report by

research2guidance entitled, “The

Mobile Health Market Report 2011-

2016”, which describes the impact

of smartphone applications on the

health industry.

As easily understandable, the

above mentioned trends are not

restricted to pioneer attempt toward

a new level for patients to acquire

and share medical information. On

the contrary, it already generated

PatientsLikeMe, a very notable

example about how collaborative

attitude can incredibly improve the

levels of treatment and quality of life

of patients.

We, in Pharma, can’t drive,

over-influence or hide

the global conversation

ePatients started about

healthcare. We should be

part, and culturally lead it.

A bright mind, an anthropologist, a TED fellow, recently discovered that he

has brain cancer.

As an artist and freethinker, he decided to publish on the Net all data

regarding his disease. Unfortunately most of the data were recorded in

private data format, hence were not visible and sharable over the Net.

What did he do?

He hacked the data, and published everything on a website. Thousands

of people read the data, hundreds of physicians participated by providing

alternative information and data to him and to the medical staff.

This Italian ePatient’s story was so largely followed by the media, that the

Ministry of health declared their willingness to pass a law engaging medical

institutions to provide health exams in an open format.

This is not the end to this story as this thinker – working closely with the

authors of this whitepaper – declared:

“the ‘e’ before the word ‘patient’ is not there to testify technology. This ‘e’

is there to destroy the word “patient”, usually considered as a subset of

people with inferior autonomy, power and will (as is often the case when

someone enters in a hospital).”

The Internet is a disruptive ingredient and ePatients will leverage this

superpower to stay in the same category as the other humans. The next

word will be just “persona”.

The World After the ePatients


PatientsLikeMe is a collaborative

platform where patients and

caregivers have the possibility to

share their own experiences and

problems, in order to gather help

from people in the same condition.

The platform was born in 2004 as

a specialized sharing environment

for patients affected by Amyotrophic

Lateral Sclerosis (ALS, or Lou

Gehrig’s disease), a chronic and

disabling neurologic illness, which

has an average fatality rate of

39 months from early onset. A

very famous ALS sufferer is the

prominent physicist Stephen

Hawking; also a most unusual one,

having survived the illness for more

than fifty years.

The PatientsLikeMe (PLM) virtual

environment was ideated by the

families of ALS patients, who were

searching for advice and support

about how to better cope with the

progressive decline of their loved

one capabilities, while also ensuring

the best possible treatment and

support strategies. What started

as a simple method for gaining

support in response to a need, soon

transformed into a powerful tool for

patients, caregivers, and, ultimately,

doctors.

Despite the fact that the person for

which PLM had been conceived

did not survive the disease and

passed on shortly after, his

parents managed to gather ideas,

information and even economic

support by simply relying on

the power of crowdsourcing.

The platform was built so that

members can share with their peers

synchronic and diachronic data

about their illness and treatment

history, and also more qualitative

data regarding their personal state,

like the insurgence of depression

or mood during recovering, the

quality of life associated with both

conditions and treatments, and so

on.

As a consequence to the approach

taken, founders were able to gather

funds worth about 50 million USD

in support of the ALS Therapy

Development Institute, a non-profit

biotechnology company whose

mission is developing treatments

for ALS. Furthermore, when the

platform was opened to other

illnesses, there was a surge in

membership, which in a short

time attained more than 100,000,

distributed over about 1,200

different diseases.

When it moved outside the ALS

domain and differentiated its data

gathering to include other diseases,

PLM opened itself to become one

of the most prominent Web-based

clinical data sources in the world.

This allowed it to include services

like those bringing awareness

to Clinical Trials awareness and

scientific work. Opposite to the

traditional model for patient

enrolment into clinical studies, which

is based on the referral of patients

to researchers by traditional referral

systems like hospitals and GPs;

PLM was in the position to make

its members aware of ongoing

clinical trials all over the United

States, segmented by condition

and demographics, thanks to a

PatientsLikeMe: a case study on the power of

ePatientsAuthor: Ferdinando Scala


partnership with ClinicalTria.gov.

This allowed patients to have a

direct source of information about

which studies of interest were

on-going, and taking steps for

participating in them. This led to a

greater speed in terms of enrolment

rate (which is always one of the most

difficult and frustrating tasks for

researchers) and greatly improved

the overall statistical significance

of the gained data, due to the

larger dimension of statistic sample

available.

PatientsLikeMe is therefore a

significant hot spot of the new

operational landscape, occupied

by both physicians and pharma

industry. On the other side,

patients empowerment is not to

be treated as a menace by the

above mentioned stakeholders.

Alternatively, the very same

revolution which is empowering the

patients, is empowering pharma

marketers with new powerful, highly

measurable, and flexible tools for the

diffusion of their messages.


Over the last five years, pharma

companies have all been moving

toward the integration of digital

strategy into their marketing mix; not

longer a “nice to have” addendum,

but as an important pillar of overall

brand strategy. The rate and extent

of this integration is such that in

some cases and markets digital is

becoming immaterial, i.e. it is not

anymore a part of the whole, but

permeates all the communication

activities.

The acceleration toward the creation

of an integrated digital approach

produced a surge in the number

of digital assets available online,

typically dedicated to brand or

therapeutic area communications.

As a consequence, companies now

face a fundamental rule of digital

communications: rapid content

obsolescence. Differently from

previous operational models, whose

rhythm of content production and

diffusion was following a time scale

of approximately three months,

digital communications erase the

communicating power of content

much faster. Quite typically, content

is now considered obsolete in a time

span that ranges from thirty and forty

days maximum.

These new conditions generated a

paradox, under which companies

are forced to have a constant flow of

content in order to fuel their online

assets (if they don’t do so, assets die

quite rapidly due to loss of interest);

while not having the economic and

organizational power to generate

enough content to fill the gap.

Again, acknowledging that ePatients

(as well as eDoctors) are generating

and spreading content, and

leveraging this phenomenon, can

be the answer to an apparently

insoluble dilemma. Therefore,

content sources like collaborative

media are pivotal in allowing a digital

asset to be constantly fresh and

updated. On the other side, there

is the problem of differentiating and

selecting interesting content from the

qualitatively unsuitable. This can be

attained by individualizing the users

who produce content of sufficient

quality in collaborative communities;

and providing them with privileged

information in order to make their

content production faster and of

better quality. This way, it is possible

to build a wide panel of affectionate

users, which entertain a strong

relationship with the company, and

develop a mutually advantageous

dynamic. By accessing privileged

materials and tools, to produce better

content they will have the possibility to

shine in front of their social network;

while delivering messages from the

company with maximized quality

and credibility. And so, these content

providers become the “KOLs” of the

digital communication era.

ActiveMint is an interesting example

which uses crowdsourcing in order to

monitor and reward healthy behavior.

CROWDSOURCING AND ePATIENTS FOR MARKETINGAuthor: Ferdinando Scala


This Web-based platform gathers

data from ePatients (defined not

necessarily patients, but as healthy

people) about their daily behavior. In

particular, enrolled users continously

post healthy behaviors on their profile.

These posts range from behaviors

like taking a walk, checking in at a

gym, eating a type of food, drinking

a certain quantity of water. This

virtuous behavior is rewarded by

earning points on the platform, which

can be redeemed under the form

of gift cards and other real world

rewards. The platform generated the

interest of a number of insurance

companies, which finance the

rewards in exchange for advertising

opportunities on the platform.

What is interesting and actionable

about this example is the possibility

of using the very same approach for

patient adherence initiatives. There

is a possibility here to get patients

to adhere to a treatment schedule,

by rewarding not only the timely

dosing of their prescribed treatment,

but also providing support for

patients maintaining a more complex

therapeutic regime, such as following

a diet, practicing certain exercises,

etc. From a marketing standpoint,

this approach could be valuable to

gather reliable data about the rate of

therapy adherence, and also spotting

collective behavior which could

determinate adherence or

non-adherence, not normally

evidenced by means of customary

market analysis techniques.


Conclusions

The Internet Age has brought with it an almost infinite amount of information,

allowing anyone and everyone the resources to build their knowledge –

to build anything in fact! Crowdsourcing is an innovative way of working

together to pool and analyse more data than we could ever achieve alone.

How can you use this vast resource in your day-to-day life as a marketer?

Just spending 10-15 minutes of your searching outside of our comfort zone

of FirstWord newsletters, PM Live, MM&M, etc could open up a new world

of resources to mine for insights into the disease areas in which we work. It

could give us the opportunity to become exposed to the thoughts, feelings

and motivations of people living their lives with these diseases; sharing the

thoughts, their data and shaping their own futures.

Have you considered ePatients as a stakeholder in your marketing plan?

Whilst we cannot drive, over-influence or hide the opinions and broadcasts

of ePatients we might consider how to engage with them, or simply use their

knowledge and resources to better understand the needs and behaviours of

your most-empowered end customers.

With these new paradigms of Crowdsourcing and Big Data, the ePatient is

a force to be reckoned with, the perfect storm that will sweep through and

radically change the future of the healthcare industry.

Are you as a marketer ready to embrace this change?Want more?

Follow us on our social media stream, or directly reach out to the authors for

learning how to align your brand / franchise / organization to the mounting

wave of digitally-enabled healthcare.

30

Razorfish Healthware is a global leader in digital and healthcare

communications, leveraging a unique mix of insight, technology, creativity

and industry savvy to deliver digital innovations, solutions and tools that drive

improved health outcomes.

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interactions, and the healthcare ecosystem enables us to generate

transformational experiences that empower people’s health and wellness

decisions.

Razorfish Healthware is a single organization able to deploy our full

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professionals based in 9 countries around the world: US, France, Germany,

Italy, Spain, UK, Australia, China, India.

Razorfish Healthware is part of Publicis Healthcare Communications Group

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For more information please visit

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