My Washington colleague Tucker Warren, follows up on my earlier post about health reform with thoughts about how much the environment has changed in Washington since the last pitched battle over health care reform in 1994.

Recent health reform discussions in Washington make it easy to be skeptical – a sentiment aided by the controversy about draft legislation that carries a price tag of more than $1.6 trillion while still leaving 15 million people uninsured.

But a symposium on Wednesday reminded me just how far we’ve come on discussion around health reform.

The National Pharmaceutical Council (Edelman client) brought together key players from government, industry and advocacy to discuss reform and the role of comparative effectiveness research (CER) and evidence-based medicine (EBM).

Everyone agreed that quality and consistency of care must improve, cost must be reduced, and evidence and comparative effectiveness play a key role in determining what works. And while there was spirited debate about how to accomplish these things, there was much agreement among people who not long ago found little common ground.

It’s important to remember that in 1993, the health reform process focused primarily on engaging Washington policy wonks and the tone carried a very strong partisan flavor. Fast forward 16 years and we are seeing a much more engaging level of discussion. All stakeholders, including the general public, are being asked for input. And having all parties at the table willing to “lose a little skin” gives us our best shot at a system that places the patient at the center.

During this summer and fall, there will be plenty of posturing by all sides that will challenge even the most optimistic; but I believe health care reform will happen because voters want it (see this week’s Kaiser survey) and because the process has been much, much better. And in some ways that’s as important as the product itself.

Tucker Warren is a senior account supervisor in Edelman’s health practice in Washington, D.C.

One of pharma's biggest concerns with social media is adverse event (AE) reporting. But for an AE to be reportable, it must meet the four criteria: 1) an identifiable patient, 2) an identifiable reporter, 3) a suspect drug, and 4) the side effect. Most often online, #1 and #2 aren’t met. Last year, Nielsen even produced a report quantifying this.

To handle AE reporting responsibly, companies that have created a presence in a social media property -- such as JnJ's Health YouTube Channel -- monitor their comments before posting in order to route any AEs appropriately. Some properties, like Facebook, don't allow for monitoring of comments before posting to the Wall, so companies may choose to turn off that feature. Not great for engaging with their audience, but it does avoid the risk.

This week, UCB announced a partnership with PatientsLikeMe to launch an epilepsy-focused patient community, and will report adverse events to the FDA through round-the-clock surveillance. The community is expected to launch in early 2010 and is designed to to collect, analyze and reflect information received from people with epilepsy, regardless of their diagnosis, prognosis or treatment regimen.

Sounds like a great step towards transparency and providing patients and the pharmaceutical company with valuable information and tools while maintaining FDA regulations.

Washington is buzzing about a recent article in The New Yorker that lays at least part of the blame for increasing health care costs on the overuse of tests, surgeries and other diagnostics without regard to whether those procedures bring us better care. Even President Obama is said to have read it.

The article has energized the debate about what’s called comparative effectiveness. In short, that’s using additional research methods and/or money to target care where it’s most effective. It’s controversial because some fear it could be used mainly as a means to use costs as a reason to deny coverage.

Getting into that debate requires too much space for this blog. But what is clear is how often policymakers who want the health care system to do a better job delivering quality care are already thinking about how to engage with the people who matter most: patients. That was obvious on Tuesday at a session at the Brookings Institution, where several speakers mentioned the need for patient engagement at its most personal level.

Leading that emphasis was Carolyn Clancy, the physician who runs perhaps the most important obscure agency in health care, the Agency for Healthcare Research and Quality. Dr. Clancy’s agency could be given increased authority under some plans for comparative effectiveness. “We have to engage the patient,” for that policy to be effective, she said. (AHRQ has a website to help providers talk to patients about improving quality: http://www.talkingquality.gov/).

“We must meaningfully engage every stakeholder,” added Dr. Sean Tunis, a former chief medical officer at the Centers for Medicare & Medicaid Services. And the AARP’s John Rother said implementing new regimes that link research with medical treatment must make sure they are relevant for “people like me.”

What does that sound like to you? Almost like it’s lifted out of the New Rules of Health Engagement. Especially rule #8 – be personal.

Washington likes to use trendy phrases like “bending the curve,” when talking about slowing health care costs. But those involved in the health business – and maybe an increasing number of regulators and policymakers – understand that it’s probably more important to talk directly to consumers about what matters most to them, and to do it frequently. The long-term success of any health care reform effort, before and after President Obama signs legislation, could depend on it.

The Pew Internet & American Life Project released a new report today on “The Social Life of Health Information" in conjunction with the California HealthCare Foundation. Many of the findings support previous research, but this report focuses more on Americans use of social media content for health information and highlights shifts from previous studies.

For example, in 2000, 46% of American adults had access to the internet, 5% of U.S. households had broadband connections, and 25% of American adults looked online for health information. Now, 75% of American adults go online, 57% of American households have broadband connections, and 61% of adults look online for health information. Further, many adults now have wireless access to the internet.

Asked to assess the quality of their online health experiences, 60% of e-patients (42% of all adults) say they or someone they know has been helped by following medical advice or health information found on the internet. This represents a significant increase from a 2006 Pew report that found 31% of e-patients (25% of all adults) said that. Just 3% of e-patients say they or someone they know has been harmed by following medical advice or health information found on the internet, a number that has remained stable since 2006.

The biggest topic on the rise include fitness, which jumped from 21% in 2002 to 38% in 2008 – an 88% growth, a more rapid increase than any other health topic covered in the survey. Other topics seeing growth included

• A specific disease or medical problem (49% of adults, up from 36%)
• A medical treatment or procedure (41% of adults, up from 27%)
• Prescription or over-the-counter drugs (33% of adults, up from 19%)
• Alternative treatments or medicines (26% of adults, up from 16%)
• Depression, anxiety, stress or mental health issues (21% of adults, up from 12%)
• Experimental treatments or medicines (15% of adults, up from 10%)

Download the full report.

The Washington Post has created a forum dedicated to the health care reform debate that is consuming our nation's capital. Health Care Rx will pose weekly questions to its expert panel, spanning CEOs, academics, practicing physicians, former policymakers and patients. Hosted by Ceci Connolly, the forum hopes to provide "real-world insights into how to improve health care" and invites readers to join in the conversation and add your own suggestions.

The FDA has definitely taken strides to become more transparent, as President Obama has asked. In addition to the public meeting of the Transparency Task Force on June 24th, they have launched a new blog, FDA Transparency Blog. They plan on posting questions in the weeks leading up to the public meeting, and while comments are moderated, they have posted comments that have been critical of their practices to date.

The blog of UK-based publication John Mack's Pharma Marketing Blog News this week led with the headline “65% of psychiatrists say “no” to pharma on Facebook!”. The blog highlights an online survey conducted by Psychiatric Times revealing that the majority of psychiatrists believe that pharmaceutical companies should not be allowed to join social networking sites, such as Facebook, to promote their products.

On the face of it this may seem like a forthright rejection of the industry’s involvement in social media, but as Pharma Marketing News rightly points out, the key wording in the question comes right at the end – ‘to promote their products’. It is unlikely that the majority of people who engage in social media would want it to be used for the overt promotion of anything. The only surprise in the statistic is that the 65% is so low.

Social media is about meaningful engagement between individuals connecting because of a common purpose or shared interest (whether that is a TV show, a local restaurant, a health condition, or simply friendship). If social media allows individuals such as patients with a certain health condition or physicians with a special interest in treating that condition to interact with some of the partners involved in the management approaches of it (including the pharmaceutical industry) then why not?

Pharma Marketing News has taken the initiative to follow up the question with a more in-depth survey of people’s attitudes to how the industry should engage with social media. The results of this should prove to be quite insightful.

Did you hear that General Mills got a warning letter from the FDA? Cheerios has been promoting its health benefits -- specifically its ability to reduce cholesterol -- in packaging, TV and print advertisements for the past two years. Although they have clinical data to back it up, the FDA says they can't make those claims without applying for a new drug approval.

From pharma's view, consumer packaged goods marketers have been often looked as innovators with their use of marketing practices, especially the use of the online medium. I've worked in an agency where some of us were pharma-focused and some were CPG-focused. I often got teased by my CPG colleagues that the pharma side wasn't as creative, and it's true that pharma communications must follow strict guidelines from the FDA [that were originally created for print and broadcast and have never been adapted for the online medium]. But now, with the recent FDA warning letter about Cheerios' claims, it looks like CPG is being told, "if you want to play in our sandbox, you have to play by our rules."

I must admit I'm a bit surprised by the warning letter. While I recognize that claims by products we consume should be truthful, it seems that this is a bit over-the-top. If this is truly a concern -- that Cheerios is misleading the American public by making these claims -- then why did it take two years for the FDA to issue a warning letter? And with pharma, warning letters are a concern for the companies that receive them because they may prompt class action lawsuits. Although our society is pretty litigious, will anyone go after Cheerios for this? What do you think?

As I mentioned in my last post, Edelman has put together a global health crisis Twitter feed with employees from around the Edelman network. The purpose is to communicate official information, major developments and other important news to ensure our partners from around the world are equipped to deal with this crisis.

If you are interested in contacting any of the individuals from the Twitter feed, I’ve posted their information below. As a note, we are using “cotags” to identify each person; each cotag is noted next to their name.

United States
Thaddeus Pennas (^TP)
Vice President, New York
thaddeus.pennas@edelman.com

Megan Hueter (^MH)
Account Executive, Washington, DC
megan.hueter@edelman.com

Abby Ryan (^AR)
Account Executive, Atlanta
Abby.ryan@edelman.com

Mexico
Zerene Kahan (^ZH)
Senior Vice President
Zerene.kahan@edelman.com

Gonzalo Olivares (^GO)
Vice President
gonzalo.olivares@edelman.com

Canada
Stephanie Marton (^SM)
Senior Account Manager
Stephanie.marton@edelman.com

Laura Espinoza (^LE)
Account Manager
Laura.espinoza@edelman.com

UK
Scott Thomson (^ST)
Director
Scott.thomson@edelman.com

Marshall Manson(^MM)
Director
marshall.manson@edelman.com

Jason Michal (^JM)
Senior Account Manager
Jason.mical@edelman.com

Tom McLoughlin (^TM)
Assistant Account Executive
Thomas.mcloughlin@edelman.com

Germany
Wolfgang Luenenbuerger (^WL)
Director
Wolfgang.luenenbuerger@edelman.com

Spain
David Moran (^DM)
Senior Account Manager
david.moran@edelman.com

France
Odile Tardieux (^OT)
Senior Account Executive
Odile.Tardieux@edelman.com

Italy
Alberto Mengora (^AM)
Senior Account Executive
alberto.mengora@edelman.com

Scandinavia
Hakan Jarlenius (^HJ)
Account Director
Hakan.Jarlenius@edelman.com

Indonesia
Mayang Schreiber (^MS)
Health Practice Director
Mayang.schreiber@indopacedelman.com

Communicating during a public health emergency requires a dedication to keeping people informed as quickly as possible. That’s certainly necessary now for companies, government agencies and non-governmental organizations dealing with the swine flu emergency.

The U.S. Department of Health and Human Services began planning for a flu pandemic three years ago, as the AP noted , but in the digital age that was generations ago. The need to communicate effectively and clearly has only increased since then, but thankfully the tools available to do so have become more useful for officials and consumers alike.
For its part, HHS is now aggressively using social media to update the official response to the current emergency. Several divisions use Twitter, with main flu update info at: http://twitter.com/BirdFluGov.

As global communicators, Edelman is going to do its part. Today we established our own health crisis Twitter feed, which we will use to communicate official information, major developments and other important news. Our goal is to be a curator of milestones, data and information to keep our partners around the world more informed and more equipped to deal with this emergency.

I learned more than a decade ago working as a governor’s press secretary that during an emergency, such as a hurricane, people expect their leaders to be a source of solid, practical information and advice. We’d love to know your thoughts and comments.

(Disclosure: I once worked for a division of HHS)