Jul16

“It’s not a tumor!” Cyberchondria and the Diagnoses That Spawn From It

2287994It’s 7 am; I’ve just awoken. My eyes are adjusting and I’m sprawled in my bed. My mind is not coordinated enough to move my body. Man, I am exhausted, I think. How is it only Thursday? My head kinda hurts. Good God I have to pee. I could probably snooze for like fifteen more minutes, if I shower quickly. Seriously, my head hurts. Right in my left temple. I must have slept wrong. I don’t remember hitting my head or anything. I sit up abruptly. Oh Lord now I’m dizzy. I’m dizzy and I have a sharp pain in my temple. Holy crap what if it’s a tumor, or an aneurism. When I did those brain cancer interviews last year they all said they woke up with headaches. This is that exact same situation. Where’s my iPhone? How do you spell meningioma, two “n”s? No, one “n.” Thanks Google. Okay WebMD…signs and symptoms…yup, here it is. Headache: check. Dizziness: check. Weakness in arms and legs: now that you mention it, I can barely hold this phone it feels so heavy. Blurred vision: that one’s probably next. Yup. It’s definitely a meningioma. I should call my dad. Just tell him I love him.

But just as Arnold said, it’s not a tumor. And while that example might be a tad exaggerated, I’ve certainly had this type of half-awake, neurotic, cyberchondria once or twice in my life. Though the above situation was more likely caused by one too many glasses of wine and a refusal to admit to a hangover.

Nevertheless, the concept of self-diagnosis is an ever-growing phenomenon in this digital age. According to a survey conducted by The Pew Research Center, over 35% of Americans in 2012 had gone online to diagnose themselves, and more than a third never confirmed that diagnosis with a doctor. What’s worse: some 30% of self-diagnosed women have admitted to purchasing and consuming medication for their supposed illness, without a consultation. That’s the part that shocks me. Sure, I might convince myself I have a pet-dander allergy, but that does not mean I trust my diagnostic abilities enough to assault my leg up with an EpiPen.

But it does happen. And those working in the healthcare industry appear to be the worst culprits—after all, we live and breathe this stuff; it shouldn’t be hard to tell if we have chronic migraines, or insomnia, or endocarditis, right? Our increased level of knowledge mixed with a splash of arrogance is just enough to convince us that there is little a PCP’s gonna tell us that we don’t already know.

And while the hyperbolic, often terminal, self-diagnoses are more my style, physicians say they are more concerned with the prevalence of under-diagnosis among systematic Googlers—as we all know, convincing oneself that a rash is just a rash, or numbness is just an innocent side effect can have irreparable effects.

Now, I’m a huge proponent of self-education and using today’s technology to our advantage—in fact, I think it sparks productive dialogue when information is brought into the doctor’s office—but as cliché as it sounds, I cannot emphasize enough the need for a professional diagnostic assessment. Trust me; the $15 copay is worth it.

Think of it this way: your doctor is your agency of record, but for some reason, you’ve decided to do your own brand website, aka diagnosis. We all know from AOR experience that your doctor is going to take one look at that diagnosis and say, “Damn, this is a mess; I wish they’d just paid me to do it.”

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Also posted in behavior change, Digital, Health & Wellness, Healthcare Communications, Medical Education, Medicine, Patient Communications, Self-monitoring | Tagged , , , , , | Leave a comment
Jul9

Is Print Dead?

4144823A lot has changed in print production since I entered advertising in 1987. Back in the day, printing was a form of art. A good printer was worth his or her weight in gold.

But how times have changed! Especially within the last four to five years. Art has taken a back seat, and it is down to price and speed. So what is a print buyer to do in this day and age? Is print going the way of the dinosaurs?

As I think about it, reviewing the latest research and trend reports, I have mixed feelings. I am a print person, I need it in my hand, but that doesn’t stop me from appreciating the digital world. It simply amazes me how far we have come since I started in this business. Google, YouTube, Pinterest, etc. You can find anything you need within seconds. How cool is that?

But hear this! Print is not dead and still has an important place. Just as radio did not bring the death of newspaper, and television did not bring the death of radio, online media will not kill off print media. A wise marketing plan must include a combination of both digital and print. Target your audience, apply segmentation, and adapt the resource allocation based on how your stakeholders prefer to receive their information. And of course, overlayed with analytics!

Print continues to have undeniable advantages over online advertising. It is narrowly targetable, highly personal, and credible to consumers. People trust the printed page. Audience specificity is guaranteed when trying to reach your customers.

In addition, print is tactile, a comfort food for the brain. Consumers are more engaged reading print, unlike websites, which are often skimmed in as little as 15 seconds. Studies have shown that people read digital screen text slower than printed paper and read less of it.

Technology is playing a vital role as well in print. Through the Ogilvy Innovation Lab and emerging technology, unique advances in printing—such as embedding video, QR codes and even adding smell into print—have not only made this channel more interactive, but more engaging as well.

Print is also relatively long-lived while being a solid vehicle for establishing brand identity. Print advertising will continue to be a viable component for an effective multichannel campaign. Understand your customers and how they want to receive information on your product by using the right vehicles:  real-time analytics will help inform your mix of online, print, collateral and event marketing to ensure your campaign is a winner.

So don’t ignore print. It still plays an important role in your brand’s promotional campaign. I just can’t help wondering how the next decade will affect the advertising world….

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Jul2

FDA Social Media Draft Guidance Released June 2014

fdaLeading up to its final guidance to be released in July 2014, the FDA has released draft guidance on how pharmaceutical companies and medical device manufacturers should interact with social media platforms with regard to fair balance and brand messaging. The first part of the recently released recommendations is focused on how companies post advertising and promotional messages to Internet and social media platforms with character space  limitations, such as Twitter and Google Sitelinks. The second part of the recommendations addresses how pharmaceutical and medical device companies may correct independent third-party misinformation about their brands online. While this guidance is recommended and not required, it will be beneficial for pharmaceutical companies to adopt the FDA recommendations going forward.

A brief review of the FDA recommendations is listed below, along with suggestions for practical implementation.

Internet and social media platforms with character space limitations

In its draft guidance Internet/Social Media Platforms with Character Space Limitations—Presenting Risk and Benefit Information for Prescription Drugs and Medical Devices, the FDA outlines its recommendations for promotion of brand and product information using Twitter and other character-space-limited communications, such as Google Sitelinks. The recommendations are direct and seek to include fair balance in each individual communication.

The most salient points are as follows:

  • Reminder communications, which call attention to the name of a product but do not make claims, are exempt from this guidance
  • The full indication must be used when making claims in a communication
  • Benefit information should be accompanied by risk information within each individual communication
  • The content of risk information presented should, at a minimum, include the most serious risks associated with the product
  • A direct link to a more complete discussion of risk information about the product must be included in the communication

While a link to the ISI is adequate in such communications, the FDA further recommends that companies develop landing pages devoted exclusively to the communication of risk information about their products (e.g., www.product.com/risk). The format for the URL and landing page should clearly communicate that the destination will explain the risks associated with the product.

Many social media tools automatically use link shorteners to keep within the character space limitations of the communications. While the FDA does not directly oppose the use of shorteners, it recommends that the resulting URL denote to the user that the landing page contains risk information. (For example, prod.uct/risk clearly communicates that the destination is about risk.) Another solution to character space limitations is for the company to register shorter domain names that can then redirect to its product sites for use in social media.

One challenge that brands with black box warnings will face following this guidance, especially on Twitter, is in fully communicating risk information within a single tweet. For such brands it will be impossible to communicate all risks in the platform-restricted space; therefore, we recommend against using Twitter as a channel to communicate those products’ indications, benefits, and risks.

The FDA guidance also extends to paid search communications, such as Google Sitelinks. The Sitelinks feature displays up to 6 additional destination URLs for users to choose from when a paid search ad is displayed. In complying with the FDA’s draft guidance, most of the additional destination URLs provided by the brand would link to risk information in an attempt at fair balance, which might portray the product as riskier than it actually is. This might deter some companies from using Sitelinks to promote their products.

Correcting third-party misinformation

The second round of draft guidance from the FDA, Internet/Social Media Platforms: Correcting Independent Third-Party Misinformation About Prescription Drugs and Medical Devices, seeks to improve the quality of public health information by allowing companies to correct third-party misinformation that they find online about their products. Again, these are recommendations; it is not required that a company respond to such misinformation, regardless of whether it appears on a company’s own forum or on an independent third-party forum or website.

The FDA defines misinformation as positive or negative representations or implications about a company’s product by an independent third party. There are two types of misinformation: a misrepresentation of the label, which a brand will typically want to correct, and an exaggeration of outcomes, which a brand may be tempted to leave uncorrected. The FDA recommends that companies respond to both types of misinformation.

If a company decides to correct misinformation on a third-party site, it should:

  • Provide corrective information and a link to corrective information
  • Post corrective information alongside the misinformation or refer to the misinformation in its response
  • Limit the scope of the corrective information to be specific to the misinformation, and keep it non-promotional
  • Correct positive misinformation as well as negative misinformation
  • Keep records of corrective interactions

The FDA clearly states that it will not hold a company accountable for an independent third party’s subsequent actions or lack thereof after corrective information has been supplied. Further, companies do not have to continue to monitor the third-party site after information has been corrected.

Going forward

While it is not feasible for a company to monitor all third-party sites for misinformation about its products, creating Google alerts (or similar) will help ensure that it is notified when user-generated content (UGC) about its products is trending. A company can then respond appropriately if they desire. However, consideration must be given to the level of time and effort that legal and regulatory teams must spend reviewing and filing the corrections versus the impact smaller third-party sites and individual bloggers can have on public health information.

Alternately, a company can and should focus its attention to more prominent third-party sites, such as WebMD, Wikipedia, and brand-specific hubs, in their quest to correct misinformation. This will maximize the intention of correcting the message while appropriately weighting the effort.

Overall, the draft guidance marks a significant milestone in the pharmaceutical industry’s ability to keep pace with other industries in the social media space where consumers are increasingly seeking out health information. This guidance has been a long time coming, and now pharmaceutical companies can jump into social media knowing they will be FDA compliant when the final guidance is released.

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Jun4

The Future of Journalism

reporter with camWatching the BBC news the other night, my partner Ben turned to me and asked, “What’s wrong with that reporter’s eyes? It looks like he’s checking himself out in a mirror somewhere.” He was right, the reporter was checking himself out, but it wasn’t in a mirror – he was looking at himself in the viewfinder of his video camera. Much like Tom Daly in his famous ‘coming out’ video – this journalist was recording himself, making the rookie mistake of not locking eyes on the lens, but rather admiring himself.

Video journalism, where the TV news reporter has no crew and does everything themselves, is not new. In fact a decade ago, it was touted as a great way to break into the industry as a rookie reporter. Usually video journalists worked for small television stations or were covering stories in remote parts of the world – on their own. Few people wanted to do it, so video journalism was reserved for stories which didn’t warrant standard quality pictures or audio – I mean you can forgive the shaky or out of focus pictures when the story is coming from war-torn Bosnia!

In this instance, however, the story was coming from the relative safety of East London. Why then, with Broadcasting House virtually in shouting distance, is the Capital’s premier news service using video journalists? The fact is, video journalism has become mainstream and is virtually compulsory on metropolitan newscasts and 24 hour news channels. As public relations practitioners, we’re acutely aware of shrinking newsrooms and cuts to editorial staff across the news media – and healthcare media are no exception. The rise of video journalism is one way on-the-spot reporting has survived in a budget conscious media environment. In fact, some online medical media outlets have actually grown their video news in recent years.

So, in a post ‘information superhighway’ world (remember that chestnut?) where to for journalism? The truth is, news tastes are driven by the audience and as an audience, we’re increasingly less willing to wait for carefully gathered, edited and produced news.  Journalism today is a constant tug-of-war between getting it right and getting it right now – and it’s hard to foresee this trend changing.

Immediacy is increasingly trumping quality as a battle for the ever illusive scope wages on. Journalists are fighting bloggers, gossip merchants and even Joe Public to break a story. The only trouble is, professional journalists have the onus of at least trying to get the facts right.

So not only must a journalist get the story out first, she must also be seen as an authority on the matter and be the most prolific reporter. How else would she have any cred on Twitter? When success as a journalist can equally be measured in Twitter followers as the quality of their work – journalism today requires balancing one’s online clout with actually producing quality news copy. So worried is the BBC about the focus moving toward the former, it issued guidelines in 2012 warning journalists not to break a story on Twitter before informing their newsroom colleagues.

As PR’s, we’re increasingly aware of evolving our output to service the needs of the busy multi-platform journitator. After some tweetable nuggets? Every press release will contain some. Need an on-the-spot TV studio for a quick video interview? We’ve got one waiting for you. Want to write your story two weeks in advance for an autofile while you’re trekking in the Himalayas? No problem, we’ll sort you out with an embargoed brief and interview.

It’s hard to say how journalism will evolve over the next decade, but it’s clear the pressure for immediacy is about as high as it could possibly get. With this immediacy comes a power shift from the outlet to the story teller themselves. For the time being at least, this opens up a broad opportunity for PR’s to offer tailored content across multiple platforms – albeit to a shrinking number of journalists.

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May14

Social Media for Pharma?

stethoscope social mediaHave you been looking for a way for your brand to engage in social media? Are you unsure of what the draft FDA guidance on social media means? Looking for some tips to help get you started? If so, you’re in the right place.

Social media has been an integral part of the digital marketer’s toolbox for several years. It is especially useful for driving brand awareness and generating site traffic. Unfortunately, due to the tightly regulated nature of the pharmaceutical industry, many have been reluctant to implement social media campaigns. Brand marketers have avoided them due to a lack of clear guidance from the FDA, and medical/regulatory review teams have refused to approve social campaigns due to the fear of receiving a dreaded FDA letter.

With the release of draft guidelines by the FDA in January, our industry has been provided with long-awaited parameters. Final guidelines have yet to be issued, but this is a step in the right direction. Slowly, pharmaceutical marketers are dipping their toes in the water. Here is a quick overview of the FDA’s guidance:

  • Brands are responsible for monitoring the content they publish. Content that is repurposed, posted, or used in an inappropriate way is not the responsibility of the pharmaceutical company (as long as the individual repurposing the content is not employed by the pharmaceutical company).
  • Pharmaceutical companies are not responsible for content published by associations and other partners that it provides with financial support (eg, unrestricted educational grants). Content and assets provided are the responsibility of the pharmaceutical company and must still go through typical FDA sampling.
  • Pharmaceutical companies and their representatives must clearly identify their association with brands when participating in conversations.
  • Fair balance is still in full effect. As with any other promotional medium, claims must be counterbalanced with the risks of the drug.
  • FDA submissions of interactions do not have to be submitted in real-time. Conversations that take place can be sampled after the fact to keep brands in compliance.

You can access the full document here.

Feeling more comfortable with the guidelines? Are you ready to deploy a social media campaign? Here are some tips to get you started:

  • Start with a strategy. As obvious as this seems, people are so anxious to implement a social media campaign, they dive in headfirst. Ensure you identify the goal of your campaign so you can measure the results of your efforts.
  • Engage in conversations with your audience. People use social media to connect with people, rarely with brands. Talk to them about topics that matter to them and are appropriately linked to your brand (eg, an antidepressant sponsoring a support forum providing tips to patients and caregivers on ways to remain positive and the importance of adherence).

According to a 2012 channel preferences research report published by ExactTarget, Facebook and Twitter rank at the bottom (4% and 1%, respectively) of channels participants want used for promotional messaging. This accentuates the importance of finding a healthy balance between brand promotion and human interaction. You can access the research here.

  • Messages must be relevant and fresh. They must take into account the context, location and intention of your audience. Not every opportunity that arises to share your marketing message should be taken. Selectivity is part of the secret to success.
  • Be flexible. The future is unpredictable. For brands to thrive in social media, they must be ready to act in the blink of an eye. Editorial calendars should not be set in stone.
  • Listen closely to the feedback of your audience and take action. The most insignificant of posts can take on a life of its own, leaving marketers scrambling to control the fallout.
  • Always have a social media crisis plan in place. Sitting idly by and not taking action is tantamount to brand suicide. Does anyone remember #mcdstories, #askJPM or #myNYPD? If not, hop on Twitter and search for the aforementioned hashtags. All are examples of hashtags that turned into “bashtags” and left their respective marketing agencies scratching their heads and scrambling to minimize the damage.

Although the pharmaceutical industry is heavily regulated, social media is an opportunity to connect with your audience and should not be overlooked. With the draft FDA guidelines in hand and a sound strategy, you can now connect with consumers through social media.

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Apr17

Multi-Screen Is the New “Mobile First”

screensFor the past few years, “Mobile first!” has been the rally cry of marketers. The idea was to design websites and ads to work on mobile devices first to account for the growing smartphone- and tablet-using audience. But mobile first is already obsolete; if your strategy doesn’t have multiple screens in mind, then your strategy is out-of-date.

Time spent on mobile devices is steadily increasing. Throughout the day, consumers are moving seamlessly back and forth between many devices, from laptops to smartphones to tablets to TVs. In fact, 90% of consumers start a task on one device and finish it on another. Oftentimes consumers are using more than one device at a time, fluidly flipping back and forth between screens.

This complexity in user behavior makes it imperative for marketers to embrace a multi-device strategy, not just a mobile-first one.

You must now develop ads that work across these multiple devices. The ads should seamlessly leverage the characteristics of each device for optimal user experience. Additionally, where consumers used to be focused on one device at a time, now they are on multiple devices simultaneously, so messaging needs to adapt to the multi-device paradigm as well.

Consumer search trends support the need for multi-screen advertising. According to eMarketer, U.S. mobile search ad spending grew 120.8% in 2013, contributing to an overall gain of 122.0% for all mobile ads. Meanwhile, overall desktop ad spending increased just 2.3% last year. Marketers should not only develop ads for multiple platforms, they should optimize their spending across platforms as well.

Ad targeting also becomes paramount in the multi-screen world. Targeting ads to specific devices and operating systems is the most basic method of mobile ad targeting. But much like the desktop environment, user insights can be culled from the type of content consumed on tablets and smartphones. These insights can then be used to further target mobile audiences.

As consumers continue to access content across multiple devices, marketers must continue to grow and change with them to meet their needs no matter which device(s) they are using.

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Apr3

Benefits of Rich Media

The digital pharmaceutical advertising market is proving to be a growing and changing market.  Gradually over the past couple of years, more innovative tactics have become more relevant. Rich media is one tactic that has become more widely accepted not only by pharma companies and advertisers, but also by publishers. Some of you may be asking, what is rich media and why is it becoming more popular?

Rich Media Banner—This is an ad that can contain images and/or video and involves some kind of user interaction which can elicit strong user response. The ads can include multiple levels of content in one placement.

what_is_rich_media_small

 

 

The benefits of using rich media:

Ads Expand—The creative expands when the user interacts with the main image (for example, by clicking or mousing over it). This allows for a larger area to display more robust information, creative artwork and messaging while still being able to include a scrolling ISI and creative assets (videos, clinical data, polls/surveys, etc).

Breaks Through Banner Blindness—Banner blindness is a phenomenon in web usability where visitors to a website consciously or subconsciously ignore banner-like information, which can also be called ad blindness or banner noise. Rich media ads are more attention-grabbing and interactive, which helps separate them from being banner-like. Rich media banners also have proven to outperform standard display banners in key metrics such as time spent and interaction rate.

Information—Rich media banners can contain a significant amount of information, especially compared to standard display ads. This information can consist of videos, charts, clinical data, polls/surveys, or multiple creative messages. This allows advertisers to reach a larger target audience while also providing more options for multi-indication brands in one banner ad.

Metrics—The metrics in rich media banners are also greatly improved. Rich media offers standard metrics and also custom metrics. Standard metrics are more commonly known and consist of metrics like total display time, number of expansions, interactive impressions, and interactive rate. Custom metrics are added to components within a rich media banner, and only three different types are used: exits, counters and timer. These custom metrics can actually track a variety of calls to action within a rich media banner, like links within the banner, time spent on certain screens or data, and of course any click-through calls to action. These robust metrics offer a huge advantage over standard display banners which rely heavily on impressions and clicks.

User Experience—Overall user experience is improved through the use of rich media. The creative messaging can be so robust within a rich media banner that a call to action such as a click-through is not required. This actually allows users to stay on the same page where they saw the rich media banner, as opposed to clicking on a non-rich media banner that takes them to an entirely new page.

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Mar25

SXSW 2014: True Potential of Social Media in Healthcare Is Still Ahead of Us

sxsw logoOver a single-week period, SXSW Interactive hosts hundreds of presentations and panels. What was interesting to note this year, compared to the last few, is that a large percentage of healthcare discussions were now hosted on the stages of the two main convention centers, alongside all major celebrity keynotes.

Among many trends and ideas that were discussed, two concepts mentioned at the “What Happens When Tech and Healthcare Meet” panel were quite memorable. Although these are just mere single examples, each testified to a number of current trends in healthcare.

Concept: DermLink—a social network-based platform that allows patients to digitally share skin conditions with dermatologists and receive real-time responses.

Why this is important: This is especially relevant to those outside major metropolitan areas, where a wait to see the local dermatologist can exceed a few weeks. We’ve all heard success stories of doctors tapping into a broad pool of peers via Twitter and Facebook. But this platform is among the first controlled, social, care-specific environments that could potentially redefine the approach and expectations for doctor-patient interaction.

Bottom line: Regardless of the success of this platform, the mere fact that this platform is gaining momentum is an indicator that the true potential of social media in healthcare is still ahead of us.

Concept: Covered—a platform that helps applicants select the most appropriate health insurance by posing a series of qualifying questions in a standard, conversational language.

Why this is important: Although standard applications have been around for quite some time, we’re starting to see a shift in the way even insurance companies need to structure their communications. Over the past decade, we’ve witnessed a similar shift in practically every single aspect of marketing communication etiquette due to social media. A simple, well-timed response to a tweet can gain greater consumer loyalty than a multimillion-dollar Super Bowl ad.

Bottom line: Consumers no longer want to be talked at. They want to be spoken with. This is no longer breaking news…rather, a well-known fact. But at last it is finally beginning to change the insurance companies’ tone of interaction with potential applicants.

SXSW Series:

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Mar20

The Best of SXSW 2014

sxsw logoI could give you a top 10 list or a top 5 list of what was best at SXSW. That would be great if I were trying to convince you of why attending SXSW is an amazing learning experience. However, what I’d like to provide is the best single thing I learned, and get into some actionable details.

So, I was ready to get into what seemed to be a great talk. I was on line waiting, about a dozen people away from the door, when I heard, “Sorry, this session is full.” So with that news I went next door and found a talk titled, “Let’s Get Physical—Design + Embodied Cognition,” by Michael Hendrix, Partner and Creative Director at IDEO. By chance, I’d just found what was to me the best talk of SXSW.

Embodied cognition is the theory that the human mind is largely determined by the form of the human body. To simplify, the mind is experiencing the world through all our senses. The more senses that are stimulated, the more powerful the experience.

The really interesting part of this is that our minds cannot really differentiate a real experience from an imagined one. For example, when we go to the movies and experience an action-packed film, we are experiencing intense visual and aural senses. Our reaction to this fabricated experience is that we may be sitting forward in our seat, our heart rate may increase and the palms of our hands may even sweat. Our minds are telling our bodies to react to the imaginary experience as though it’s real. This is powerful stuff. The more senses we engage in an experience, the more our minds take that experience in and make it memorable.

Brands are already using this principle to design their products to convey a certain aesthetic to potential buyers. One example provided at the SXSW session was that BMW makes the hinges on their car doors heavier to convey quality and safety. People who are looking to buy a car will place a premium on a safe, well-built car.

So how does this apply to our world of marketing? Well, let’s say we are creating an iPad piece for sales reps to detail to doctors. It is common for these to include some basic ways of swiping or tapping to navigate to content. Additionally, it is the sales rep who is usually using the device. However, if we want to make this experience memorable for doctors, we should put the device in their hands and tap into more of their senses. We should think about including interesting visual and audio content. Additionally, we can use the interactive capabilities of the iPad to engage even more of the senses. For example, the iPad will recognize with its built-in gyroscope if it’s tilted or moved in a three-dimensional space, with its motion sensor if it’s shaken, or with its multi-touch screen if it’s touched with multiple fingers.

This may sound like fun and games or interaction for interaction’s sake but there is real scientific research that backs up communicating this way. The more we can tap into human senses when we communicate, the more powerful and memorable the communication will be. And remember, that goes for real and imagined experiences. This is an idea that can breathe new life into the way we think about our clients’ needs.

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Mar13

SXSW 2014: Technology and Society

sxsw logoIn Part 2 of his SXSW blog series, Robert Egert recaps some of the SXSW themes that are transforming the way the world looks at technology and society.

THE GREAT MERGE
The Idea: Society and technology are now one.

Ubiquitous mobile access combined with digitization of every aspect of our lives means that what happens online is no longer a reflection of our society but it is society itself.

The implication here is that we need to look at the way we govern the Internet no differently than the way we look at governing our nation. You can’t have a free society without having a free Internet.

One example of how this can play out is apparent in the attempts by autocratic regimes to limit access to the Internet by creating firewalled, state-sponsored Internets. Iran, North Korea and Cuba are just a few countries that have major censorship programs in place, but it is also worth noting that many large nations— most notably China—have pervasive censorship mechanisms in place.

Why this is important: As society continues to migrate social behavior (commercial, interpersonal, financial, etc.) to the digital space, unrestricted access will be a political, social, and commercial issue with substantial impacts to business, human rights, education, and social stability.

SURVEILLANCE AND PRIVACY
The Idea: Big data brings with it the threat of totalitarianism.

Everything we do online leaves an indelible record. Our searches, browsing history, comments, Facebook likes, text messages, tweets, and shopping carts are all recorded, stored, and subject to analysis by companies and scrutiny by governments. Taken together, this data can paint a detailed picture of almost every aspect of our lives.

In a live streaming interview from his embassy refuge in London, WikiLeaks founder Julian Assange spoke of the inherent dangers this data poses to a free society. He suggests that the extensive collection of personal data by the NSA, for example, provides the government the ability to use personal information to control elected officials and by extension is moving toward the establishment of a total surveillance society.

Why this is important: Systems are currently in place to monitor and record our online behavior in painful detail. These systems can be abused. We may be entering a world without the options of privacy or anonymity. This brings significant threats to democratic values and a free society. For those of us in the healthcare industry, we can expect privacy to continue to be a hot button topic, and initiatives that require collection of personal data will require careful consideration for protection and privacy.

ROBOTICS, DISRUPTIVE TECHNOLOGIES, AND UNEMPLOYMENT
The Idea: Technology and robotics reduce the need for workers.

When WhatsApp was purchased for $19 billion, they only had about 50 employees. Like many new social and tech businesses, WhatsApp relies on the aggregated social activities of its many users to produce value. But unlike traditional employees, users of apps and social networks are not compensated for their efforts.

Similarly, while manufacturing is on the rise in the US, many of the manufacturing operations that used to be performed by humans are now performed faster and more accurately through robotics.

Another example is self-driving cars. Though still predicted about ten years from widespread commercialization, self-driving cars promise the benefits of safety, speed, and fuel economy, but will also put every taxi, truck, and bus driver out of work forever.

Viewed at a macroeconomic scale, technology produces value and wealth but not necessarily jobs.

Why this is important: Without robust employment, the consumer economy will suffer. We may need to seriously think about implementing models of compensation for user-generated content.

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