Mayo Clinic Takes on Facebook

On the same day that a Wall St. Journal article speculated that Facebook could be worth $100 billion by the time it goes public early next year (as has been rumored), the Mayo Clinic announced that it has launched its own online social networking community.

Via Koreshky at Wikimedia Commons

And it may be the first medical provider to do so. The Clinic says it knows of no other health system that has a social network.

The week-old community doesn’t have a catchy name, but it is populated with all the features of Mayo Clinic’s already robust online presence. The Clinic says it has the “most popular medical provider channel on YouTube, nearly 200,000 followers on Twitter and more than 53,000 connections on Facebook.”  It also has a library of condition-specific podcasts and a blog highlighting medical news from the Clinic.

The networking site will be “a place for community members to share information, support and understanding,” the Clinic says.

Essentially, the network aggregates all the Clinic videos, podcasts, and news and allows for interactive discussions on topics ranging from arthritis to travel to the various clinic sites. Just like on Facebook, users can “like” a topic or add their own comments to a post.

With so many chat rooms and discussion boards out there–not to mention that advocacy groups and individuals use Facebook to solicit and give advice on health conditions and share experiences–will the Mayo network attract many users?  The Clinic says that some 1,000 people have joined in the first week of operation. It’s open to any and all comers, not just Mayo patients or their families.

Presumably, the ultimate number of users won’t be of great importance to the Clinic, although it is potentially a great marketing tool. The Clinic also doesn’t have to worry about satisfying venture capitalists or stockholders.

But maybe Facebook should be worried.

—Alicia Ault (on Twitter @aliciaault)

Diabetes Intervention Showdown: Humans vs. Technology

Which is more effective in helping people who are at high risk for diabetes avoid the disease: a face-to-face “lifestyle intervention”? An Internet-based version? The same thing on a DVD? Or letting patients choose the version they want to pursue? And when you factor in the costs, which one is most cost-effective?

Image by Kevinsendi (Wikimedia Commons)

Such are the questions upon which health policy may rely. At the American Diabetes Association meeting, researchers from the University of Pittsburgh provided some answers that may surprise you.

The prospective Rethinking Eating and ACTivity (REACT) study enrolled 434 overweight adults with abdominal obesity in eight rural communities in southwestern Pennsylvania. Already I’m thinking, not exactly Silicon Valley, but what do I know about their technological experience?

Participants were randomized to one of four groups with various versions of a “group lifestyle balance” program that aimed to educate them about physical activity, weight loss techniques, and other ways to make healthy changes to their lifestyles. The face-to-face version (119 people) involved weekly group education sessions for 12 weeks. The 113 participants in the DVD group watched 12 group lifestyle balance sessions on DVD and met with healthcare workers four times for debriefing about the DVDs. The Internet group (101 people) experienced 12 group lifestyle balance sessions that were incorporated  into an online format with blogging and e-mail capabilities.

The final 101 participants were randomized to a “self-selection” group that allowed each person to decide which format to use. Sixty percent chose the Internet program, 40% chose face-to-face group meetings, and not a single person picked the DVD. (Sign of the times? I think I’ll put my CD/DVD shelves on eBay before they become worthless.)

The good news is that all versions of the lifestyle intervention worked, said Shihchen Kuo of the university’s department of epidemiology, who focused on a cost-effectiveness analysis. Elsewhere at the meeting, his associates presented separate analyses of 6-month follow-up data suggesting that letting patients choose the type of program provided the best outcomes. Participants in the self-selection group showed the largest improvements in physical and mental functioning and were 1.5 times less likely to have impaired fasting glucose compared to the other groups, though at least half of each group met the goal of losing 5% of their weight. Among those who lost weight, 80% kept it off at the 6-month follow-up, according to a university press release.

But effectiveness is only half the story when setting policy. Cost is the other half. Using preliminary data from the first 3 months of follow-up to model results at 3 and 5 years, the face-to-face program dominated the others in cost-effectiveness, Mr. Kuo reported. Adherence rates were 76% in the face-to-face program, 57% with the DVD, 53% in the self-selection group, and 38% using the Internet. The Internet-based program cost the most to operate, he said.

Projected out to 5 years, the face-to-face program would cost $63,377 per quality-adjusted life year compared with no intervention, he estimated, well within the range of many commonly accepted medical interventions.

It will be interesting to see if the cost-effectiveness results change when considering 6-month outcomes and become more closely aligned with the 6-month results for effectiveness. For now, though, “the face-to-face group lifestyle balance strategy delivered in rural communities is a sound investment” when choosing between the three models, Mr. Kuo concluded, “and appears to be economically reasonable” compared with doing nothing.

For those of you keeping score at home, I’d call this a tie — Humans 1, Technology 1. Would you agree?

–Sherry Boschert (@sherryboschert on Twitter)

Social Media Lack Privacy, a Problem for Psychiatrists

Many psychiatrists of, ahem, a certain age (say, over 30) have been caught by surprise by the reach of online and social media. With the explosion in use of the Internet, e-mail, Google, Facebook, Twitter, LinkedIn, and many other ways to find out information about someone, there’s no such thing as privacy any more. That creates a new set of modern problems for psychiatrists who walk a fine line between building a therapeutic alliance with patients and keeping a professional distance.

Image captured by flickr user smemom87.

I sat in on a fascinating group discussion at the annual meeting of the American College of Psychiatrists to hear how professionals are grappling with these issues. Look for a more detailed report soon in Clinical Psychiatry News. What surprised me is that even some very young psychiatrists who grew up so immersed in online and social media that they seem like part of the natural environment have been surprised by the professional ramifications of the long reach that these tools give to patients.

Some of the challenges are old problems in a new form, it seems. Setting limits on patients’ e-mail contact with psychiatrists is similar to setting limits on phone contact in some ways, but magnified. The Internet and e-mail can be both helpful and problematic in their work, psychiatrists said. The biggest potential land mines are in the social media. What happens when a patient wants to “Friend” a psychiatrist who is on Facebook? No matter how the psychiatrist responds, there’s grist for the psychoanalytic mill. Transference becomes a bigger issue. Even using the highest privacy settings, non-Friend visitors to your page can glean information about you, your ”Friends,” and potentially your family. Perhaps not surprisingly, only a handful of psychiatrists in the room said they were on Facebook. And Internet dating? Look out.

Does that mean psychiatrists must be technological hermits, never to enjoy the interconnectedness that social media supply to everyone else in society?

These are all weighty questions that usually have no right or wrong answer. The American Association of Directors of Psychiatry Residency Training (AADPRT) just released new curricula to guide psychiatrists-in-training in discussing these issues, so that they can anticipate the potential consequences of the decisions they make about use of online tools and social media. See my full story for details.

The curricula are available only to AADPRT members, though some of the resources in them may be made available to the general public in the future, said AADPRT President Dr. Sheldon Benjamin. Meanwhile, you can hear him discuss these topics in an AADPRT podcast interview with Dr. Sandra M. DeJong, chair of the Association’s Task Force on Professionalism and the Internet.

I’d love to hear from clinicians of any specialty who are reading this (but especially psychiatrists) — do you use social media? Are they worth the potential professional problems? And will you Friend me? Leave a comment, and let us know.

– Sherry Boschert

For Parents Who Worry about Newborns and Cyberspace

Registration packets were bulkier than usual at the American Academy of Pediatrics national meeting this year because they contained complimentary copies of two new books that comprised an interesting juxtaposition. Both were published by the Academy.

First is the updated, second edition of Heading Home with Your Newborn: From Birth to Reality (September 2010). Two pediatricians who also are moms (Dr. Laura A. Jana and Dr. Jennifer Shu) offer information and advice aimed especially at first-time parents who may be feeling curious, anxious, inadequate, and just plain tired as they bring their new baby home and enter a life of day-to-day care for this new little being.

The book includes fresh sections on vaccines, choosing a child care provider, early learning, car seats, safe sleep, cord blood, postpartum depression, vitamin D, organic formulas, disposable vs. cloth diapers, newborn hearing screening, what to keep in your medicine cabinet, and more.

It’s a lot for new parents to take in. And that’s only the beginning — in the blink of an eye, parents will be moving on to the second book, CyberSafe: Protecting and Empowering Kids in the Digital World of Texting, Gaming, and Social Media (October 2010). Every young kid today is what author and pediatrician Dr. Gwenn Schurgin O’Keeffe calls a “digital native” — someone who has never known a world without the Internet, social networking sites, mobile communication technologies, gaming, virtual worlds, texting, and sexting.

The teasing and bullying that many kids experience in the “real world” has followed them into cyberspace. One in five kids will experience online abuse by the time they are in high school, Dr. O’Keeffe notes. I’ve seen this first-hand since my nephews got me onto Facebook and allowed me to Friend them. (Digital immigrant, c’est moi.) I’ve seen some kids taunting and bullying others in their posts.

But you know what? I’ve also seen kids stick up for each other, perhaps more so online than they would have in person. And when one kid vented about his frustrating family and said he would run away from home, his peers rallied around him and encouraged him to think more calmly.

Parents need to know that no matter where their kids will be, they need to be involved, whether it’s in school, on the playground, or on their cellphones, MySpace or Twitter. CyberSafe can help them and their kids be cyber-smart.

–Sherry Boschert (@sherryboschert on Twitter)

Everyone’s an Expert

From the spring meeting of the American Thyroid Association  in Minneapolis  

During this meeting, Dr. Linda Barbour gave a talk on the difficult subject of managing patients with Graves’ disease during pregnancy.  Something she said about the Internet really caught my attention because it’s a theme that I keep running into at medical meetings.  She was describing a patient in her mid-20s, who was already on thyroid medication when she became pregnant. “She’s really scared.  She’s gotten on the Internet and she thinks that she’s going to have a baby with all kinds of terrible problems,” said Dr. Barbour, who is a professor of Endocrinology, Metabolism, and Diabetes and Maternal-Fetal-Medicine at the University of  Colorado.

Courtesy of Flickr user Jenny Lee Silver (CC)

 The advent of the Internet and broadband means that lots of patients have access to reams of medical information–some of it evidence-based from renowned medical and health organizations and some of it complete bunk and quackery.  The question is whether the average American has the critical thinking skills to evaluate all of these sources and sift the wheat from the chaff.  The answer is left as an exercise for the reader.

 Still, there are plenty of folks out there who believe that they are experts after a couple of nights spent reading anything that they can find on the Internet about a health condition. They believe they know as much as physicians and researchers, who have years of education and experience with that condition and who have peer-reviewed literature on their side.

 In principle, an informed patient is a good idea.  But can an informed patient in the Internet age be a hindrance to physicians as well?  Is a little knowledge really a dangerous thing?

 We want to hear from you.  Has the Internet changed the patients that you see?  In what ways?

 —Kerri Wachter, @knwachter on Twitter

  

Are virtual medical meetings the wave of the future?

It’s now possible to go to a medical meeting without actually going to the meeting.

I was assigned to cover the annual Conference on Retroviruses and Opportunistic Infections (CROI), one of the year’s most important HIV/AIDS meetings, currently underway in San Francisco. But through a series of snafus too boring to mention I was not able to register for the conference.

No problem, said the organizers, more than 90% of the conference will be webcast.

I’ve heard this song before, and usually it means that at some distant future date some low-quality audio may be available for purchase at the rate of $40/session or thereabouts.

But I was pleasantly surprised to learn that CROI is offering much, much more. The webcasts are free, they include high quality audio, video, and PowerPoint slides, and the day’s sessions are all available the same evening. Oh, and the audio files, with slides, are also available for download in mp3 and iTunes format. For free.

Virtual attendance via webcast has both advantages and disadvantages compared to physical attendance in “meatspace.”

Advantages

• No need to pay for travel, hotel, or even meeting registration.
• Smaller environmental impact.
• Can attend all sessions, even ones occurring simultaneously.
• Can clearly hear and see the speaker, the slides, and participants in the Q&A session.
• Can pause and rewind audio, study PowerPoint slides closely, and actually read those slides that speakers introduce by saying, “Now this slide is a little busy, but . . .”
• Can attend in pajamas.

Disadvantages

• No schmoozing, no networking, no catching up with old friends and colleagues.
• Requires a fairly fast Internet connection for non-jerky video. Even with a fast connection (in CROI’s implementation, at least) streaming tended to stop halfway through a 2-hour session, and the only way to resume was to exit and reload.
• Not possible to get a sense of how interested–or uninterested–the audience was in a particular talk.
• I’m a big fan of poster sessions, but the CROI did not make the posters available on its webcast.
• No way to earn CME credit for watching the webcasts, in this implementation at least.
• No opportunity to spend time in San Francisco, one of the most exciting and beautiful cities on Earth.

I’m interested in hearing from physicians who have attended a conference via webcast. What did you think about the experience? I’d also like to hear from physicians who think this is the worst idea since bloodletting went out of fashion. Please vote in the poll and leave comments!

— Bob Finn (on Twitter @bobfinn)