FERDINANDO SCALA AND LEANDRO AGRO ON CROWDSOURCING AND BIG DATA IN HEALTHCARE

F E RDIN A NDO S C A L A - L E A NDRO AG RÒ

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

About
the authors

Ferdinando Scala is International Digital Strategist at Razorfish Healthware, a Publicis
Healthcare Communications Group company. His main fields of expertise are Strategy
Ferdinando Scala
Consulting, Digital Strategy, Digital Transformation, Digital Engagement, Digital Metrics
Modelling, Collaborative Media, Marketing and Communications, Change Management.

An Alumnus of the prestigious Nunziatella Military School of Naples, Italy, Ferdinando holds an
MSc in Biology (summa cum laude), received MBA training, and is currently pursuing a BSc in
Communications and Media.

He started his career as a researcher in the field of satellite- and airborne-based environmental
Linkedin.com/in/ferdinandoscala
monitoring, working in collaboration with CNR, CNRS, DLR and European Space Agency. He
successively spent 12 years in Big Pharma companies, holding positions in Sales, Marketing @fscalapro
and Commercial Operations at national and international level.
ferdinando.scala.phi
A passionate Wikipedia author (13.000+ contributions), on June 2011 he has been shortlisted
for becoming a member of the Board of Trustees of the Wikimedia Foundation; and he was 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 Global Director User Experience at Razorfish Healthware, a Publicis
Leandro Agrò
Healthcare Communications Group company. His main fields of expertise are Service Design,
User Experience, Interaction Design, Digital Strategy. Visiting Professor at Siena University and
Producer of Frontiers of Interaction Conference, Leandro has been awarded 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 Linkedin.com/in/leeander
published more than 300 articles mostly focused on the consequences of technology and
@leeander
innovation; he contributed to four books and gives talk at TEDx, World Usability Day, UXCON,
eTech, World Business Forum, BayCHI (ACM). leeander
In the last 15 years, Leandro, designed the first UMTS/3G user interface never 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.

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. Are
you as a marketer ready to embrace this change?

Razorfish | Healthware From Crowdsourcing to BigData February 2013 4

As the seminal book
Blue Ocean Strategy
by 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 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 healthcare industry.


KNOWLEDGE IN THE AGE OF INTERNET

Knowledge Nearly every possible question has example, Prof. Walter Lewin, from
repositories: TED, an answer to be found somewhere Boston’s MIT Open Courseware,
amongst others on the Net. This is valid if you are is one of the best professors of
searching for a theory, a point of physics on the planet – and his
Author: Leandro Agrò
view, or some relevant data and knowledge and highly entertaining
information about it. This statement, lectures are available to everyone for
as extreme as it might seem, is free on the Net.
true irrespectively to whether you
In summary, the Net is today the
are looking for the manual for your
repository of the best information
washing machine, or want to build a
ever expressed by humanity in
space rocket – or Satellite - in your
virtually every area of knowledge
own back yard!
and industry; and this knowledge
Maybe building a satellite in the becomes growingly organized in
garage is not the most practical hubs For example, TED conference
thing to do, but the fact that (TED.com) is a major destination
it is possible shows that the where everybody can find this
knowledge available to everyone type of high-level knowledge.
on the Internet even makes an Much importantly, TED is delivered
apparently impossible task as space in a lecture/audience format
exploration available to the masses. accessible to all via video. This
The same depth of information is leading conference also has a a
not limited to space exploration, but version called TED MED, specifically
could empower individuals in their focused around healthcare (http://
knowledge of other uncommon www.tedmed.com/videos).
subjects such as Physics. For
Prestigious universities, conferences
that generate knowledge useful
to the future, new generation
institutions like the Singularity
The Language Issue
University (SU), as well as individual
We can hope that “soon” (in a few decades), we will reach the tipping point investigators who have an open-
that will allow for accurate automated translations, for now we must make source mind set and raise revenue
use of the only intelligence adequate for this task: multilingual human by mean of crowd funding, all
beings. have one thing in common: they
Crowdsourcing is becoming the way to handle accurate and contextual are collaboratively building and
multiple language translation. disseminating their knowledge for
Places like TED.com or VIDEUM.com (a video portal dedicated to free on the Net. In this respect,
healthcare) are leveraging crowdsourcing to -potentially- translate and SU is one of the most important
“language enable” all content for the benefit of users around the world. examples of how this can happen.
As an institution whose mission


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

is “to assemble, educate and
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 WHAT IS CROWDSOURCING
their normal field of competence.

The reasons behind the success
of collaborative phenomenon are
Traditional knowledge building The infinite monkey
complex, and they are eloquently
models are linked to the linear model theorem
explained in Dan Pink’s TED lecture:
of thought. The organization of
Author: Ferdinando Scala
The puzzle of motivation: (http://
concepts into a coherent significant
www.ted.com/talks/dan_pink_on_
unit, like a speech, an article or a
motivation.html)
book, always requires the author(s)
In order to understand how the to plan in advance a logical structure
collaborative building of knowledge composed by “buckets”, like issues
is realized, and what implications to be addressed or chapters. These
it has for the information diffusion “buckets” had to be organized in
in general, and for the healthcare a linear concatenation, so that the
field in particular, we need to reader could easily follow the train
delve deeper in the world of of thought of the author(s). More
crowdsourcing and collaborative importantly, this kind of process
communities and projects. was considered as the only one
efficacious to 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


EXPECTATIONS 3D Printing Adapted from Gartner HypeCycle
Wireless Power BYOD
HTML5 Social Analytics
Private Cloud Computing
Gamification
Application Stores
BigData Augmented Reality
Crowdsourcing
In-Memory DB Management
Speech-to-Speech Translation NFC Payment
Audio Mining Speech Analysis
Natural Language Q&A
Internet of Things Cloud Computing
Autonomous Vehicles Mesh Networks Predictive Analytics
3D Scanners Speech Recognition
Gesture Control
Automatic Content
Recognition

Holographic Display In-Memory Analytics Biometric Authentication Methods
3D Bioprinting Text Analytics Consumerization
Quantum Computing Media Tablets
Human Augmentation
Mobile OTA Payment
Home Health Monitoring
Virtual Worlds

Technology Peak of Inflated Trough of Plateau of
Slope of Enlightenment
Trigger Expectations Disillusionment Productivity

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

CROWDSOURCING HYPE
monkey theorem”. According to building task is possible. Positioned in the Gartner Hype Cycle 2012
http://en.wikipedia.org/wiki/Hype_cycle
this theorem, if a monkey (therefore
Things consistently change when before the “Peak of Expectations”
a being not provided with human Crowdsourcing is still the “new thing”. The
experimental conditions change. opportunities to leverage this technology and
logic or sense of purpose) had a approach are in front of us, and the knowledge
When we have at our disposal we have infused in the Net is too much to be
typewriter and infinite time at its handled.
sentient and self-aware human
disposition, it would be able to build
beings, who perform voluntary
up the complete works of William
actions, which are driven by a
Shakespeare by sheer brute force,
sense of purpose, the time to build
by randomly tapping on the keys.
a knowledge artefact consistently
Even if this theorem has some reduces, in exponential relation
strong limitations, it is very important to the number of individuals or
from the conceptual standpoint. It resources available, even in the
conveys the idea according to which absence of a formal scope or
even in apparently unfavourable organization.
conditions (non-human being,
The above mentioned conditions are
random actions, lack of sense of
at the base of the crowdsourcing
purpose), by having infinite time and
concept, which first appeared
resources available, any knowledge-
in 2006 in a seminal article by


Jeff Howe in the review “Wired”. formatting pages, Wikipedia is as of
The author presented for the first now the most complete repository
time the possibilities offered by of human knowledge. One of the
the unstructured, collaborative Top-5 ranked websites in the world,
approach for business purposes. and consistently in first position in
Since then, the meaning expanded any Google search page, Wikipedia
to a significance that here we define contains 23 million articles, has
as: about 100 000 active contributors
and it is edited in 285 languages.
In 2011, it received 2.7 billion page
“The use of crowd, without
views per month from the United
any formal or hierarchical
States alone.
coordination structure
Also when examined in terms
among its members, for
of quality of content, Wikipedia
performing a certain
shows good consistency and
scope, in order to pursue
credibility, despite it being the
which, an exceptional result of unstructured work. In a
amount of resources would renowned 2005 article in Nature,
be necessary; where Jim Giles argued that for some
“exceptional amount scientific areas Wikipedia individual
of resources” means a articles had the same rate of errors
that a review of the homologous
quantity of time, money,
article on Encyclopaedia Britannica
personnel or skill, and their
(EB) could put in evidence. Even
combinations, which would
though the article was disputed
exceed the capabilities of by EB, eliciting a successive
any formal organization.” rebuttal by Nature, it remains
evident that individuals, simply
driven by their will to contribute,
Since this publication, the concept
and working in an unstructured
has exploded in a series of
way, can collaboratively achieve
applications outside the business
results which normally implied
world, of which Wikipedia is the
the construction of a structured
most well-known example.
expert panel, and the investment of
physical and economic resources.

The total Wikipedia is probably the best- More importantly, it demonstrated

encyclopaedia: known example of crowdsourcing the feasibility of an apparently

Wikipedia applied to knowledge building at a daunting scope: gathering all human
worldwide and cross-cultural level. knowledge in a single place, in
any possible language, and freely
Built from the collaborative effort
available to everyone.
of anonymous contributors, each
adding up a more or less big piece While still probably being ahead
of information, revising grammar and in terms of overall content quality,


EB fails in a fundamental aspect Once we understand the basic
of knowledge diffusion, i.e. the concepts of crowdsourcing, we are
The Credibility
availability of its contents in any ready to revert the infinite monkey
Issue
possible language worldwide. theorem, and bring our analysis on
Furthermore, even if EB would set a further level. The next questions to
Today: All places that are
mono-cultural or with a single itself to this scope, the amount of which we should find an answer are:
sender that operates in logical personnel, skills and especially a. what happens when data
broadcast, make it increasingly monetary resources would be generators are potentially infinite
difficult to gain trust. Also, on the prohibitive, and would doom the both in number and in the
other hand, it is difficult today quantity of parameters they take
project to failure.
that a “pyramid” not sufficiently into account?
open - as is typical of crowd- In summary, from the Wikipedia
b. what completely new possibilities
mechanisms - can find the vs. EB example, we can derive a
are available when data
necessary trust. general theorem, which proves itself
generators are networked into
Pyramids – as well as YouTube as correct when conditions are a system running under a set of
- were built by many. Stories, respected: cybernetic rules, which ensure
information or generally speaking, constancy, reproducibility and
“content” define who we are and analytical accuracy of measured
what we are able to do. While the “Given a collaborative phenomena?
old giants –like Encyclopaedia knowledge-building task of
Britannica that are not available The answers to these questions are
any dimension, the quantity found when examining the world of
in a print version anymore- are
silently passing in time, all the of time and monetary Big Data, the concept of Quantified
new mega-content-structure resources necessary to Self and their consequences for the
emerges on the web, shaped in
complete it is inversely healthcare domain.
ourselves in near real time.
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.”

We have examined how
crowdsourcing allows the generation
of 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.


WHAT ARE BIG DATA?

Measure Everything: If The renowned physicist Lord Kelvin technologies, they are becoming
you cannot measure it, (1824 - 1907) proclaimed, “If you an active actor in health, nutrition
you cannot improve it cannot measure it, you cannot and wellness data collection. The

improve it”. This law was designed diffusion of these technologies is
by humans to meet the needs of becoming so widespread, sensible
Science that were becoming more in terms of measured parameters,
complex. Over a century later, we and easy to carry for people, that it
continue to find this complexity in is opening a brand-new opportunity,
every moment of our working lives. called the Quantified Self movement
(QS).
Measuring everything has become
a “human centric” issue – about QS approach is to incorporate
knowledge and control in the Internet technology into data acquisition on
Age - exactly when technology was most aspects of a person’s daily
able to fill it. But more importantly, life in terms of inputs (e.g. food
measurement has emerged as a consumed, quality of surrounding
Social Need today because we are air), states (e.g. mood, arousal
living in real time in the digital sphere. and blood oxygen levels), and
performance (mental and physical).
…and this WAS just the beginning
of an incredible emergent trend:
In the Internet Age, or better yet,
The primary methodology of self-
in the upcoming Internet of Things
quantification is data collection,
Age, we do not have enough
followed by visualization, cross-
humans to take care of all sensors,
referencing and the discovery of
devices, satellites, and –in general-
correlations.
infrastructures that we create.
This powerful trend has inspired
Measuring everything is an intrinsic
numerous hardware devices (mostly
need of the technology we are
in the wellness area) that leverage
leveraging to build our world. And
components for cost reductions
actually it is also a need of the
in sensor technology, mobile
world itself, as a planet, to face the
connectivity, and battery life, and
impetuous evolution of the human
that have already become part of
footprint. Measuring everything has
everyday life of millions of users. This
already changed other industries
trend resulted in the appearing and
and Healthcare is not immune.
explosive expansion of products
like Withings, Nike+, fitbit, as well

Data sources: as software apps for smartphones
Patients are the biggest community
the Quantified Self used to track almost every aspect
in healthcare and – today –
of life.
Author: Leandro Agrò thanks to all their portable smart


Behind the QS, there is an emerging
desire for an individual to improve The day in which we will
oneself, but it is also driven by a produce more content in a
natural human tendency towards
single day, than the rest of
competition within one’s own
human history, is near at
microcosm (friends & followers).
hand.
The QS is also related to the
philosophy of interdependence, However, currently the
donating information about oneself amount of data produced by
to be used as a contribution towards humans is very much less
new knowledge about people’s than the data produced by
behaviour and habits as well as the machines.
discovery of new medical cures.

From the Pharma perspective,
QS is creating an emerging and counterparts. The evolution
immediately relevant group of of human crowdsourcing and
stakeholders. Right now, most of participation is a mixed human/
the work of data collection and machine crowdsourcing and
publication is made manually, while participation.
every day more and more devices
In the field of health, “we can benefit
become autonomous.
from the multiple data types coming
on-stream at the same time. These
include electronic medical records,
Data sources: Using pen and paper, people are
inexpensive gene sequencing,
crowdsourcing for men already able to collect and share
personal sensor data, qualitative
and machines tons of useful data. Using shared
contributions by self-tracking, and
Author: Leandro Agrò tools such as Wikipedia –or any
more”. (Cit. When data disrupts
other collaborative tools on the web-
health care)
people are able to conceive and
evolve spaces of sense and culture. We need to talk with people, as well
as to integrate in the “discussions”
Powered by sensors – ever more
of their machines.
present in many devices – and
thanks to cloud computing – a It takes us to big data, and
remote service that collects and unleashes the potential of analysing
crunches the data – people are information on a worldwide scale
re-writing their own knowledge and, for almost every possible topic or
with it, a perception of the today’s matter.
reality.
The availability of different datasets
The Net is both for humans and presents an opportunity for High
machines, and today we should Tech Companies because data
bear in mind that machines are scientists and technologists
more numerous than their human already have the skills to manage


the data. We have already done b) a limited capability of facing
something similar in the financial scientific problems, which is delimited
field, today almost completely driven by the individual and collective skills
by machines based on big data of the R&D team members; and the
analysis and relevant results can be sheer number of people, time and
found correlating the many health resources on hand.
care data sources.
As a consequence, when an R&D
Up to this moment, we established problem that is exceeding the talent
the basic concepts of crowdsourcing, pool or organizational resources
Big Data and Quantified Self, and capabilities arises, the development
we could be tempted to consider process can come to a halt, with
them as distinct and far away from huge consequences in terms of
daily reality. Quite the opposite, overall financial and operational
these technologies and trends are capability of the company.
already impacting the pharmaceutical
Crowdsourcing is a way of expanding
industry. In the following
the available pool of talent, and
paragraph, we will understand how
even gaining insights that would not
crowdsourcing is impacting R&D.
have possibly been generated, just
because the structured development
processes inherent to a corporate
InnoCentive: a case The traditional model for R&D
structure, simply would not have
study in crowdsourcing development in any company
allowed them to arise.
for pharma operating in whatever field has
always been based on the selection, Based on this concept, in 1998,
hiring and consolidation of the best some Eli Lilly executives generated
talent, which eventually produces the idea at the base of InnoCentive,
innovation suitable to be transformed a crowdsourcing platform whose
into products to be sold on the initial field of application was
market. This kind of process has the pharmaceutical R&D, but today
advantage of ensuring consistency extends its business model in other
and continuity of effort toward a areas like engineering, computer
certain objective, and it functions science, mathematics, chemistry,
well when the amplitude of problems life sciences, physical sciences and
to be solved is consistent with the business. The InnoCentive business
dimension of the R&D structure. model is based on the online sharing
of pharmacological or clinical
As a downside, having a
development problems, for which
consolidated R&D structure implies:
it is unpractical to find a solution
a) a consistent organizational effort in internally, and the call for proposals
order to select, maintain and manage to platform members. InnoCentive’s
the right people in the right place, members have thus the possibility
with huge expenses in terms of HR to contribute to the resolution
resources; of proposed problems, earning


consultancy fees for their contribution the best models.
ranging from 500 to 1.000.000 USD.
BI is actively engaged in this
The model has encountered a platform to further our business.
considerable success, to the point Predictive in silico modeling of
that today prominent organizations biological endpoints is an important
in a wide array of business sectors and useful component of the drug
like BAE Systems (avionics), discovery process. Through the
Booz|Allen|Hamilton (consultancy), construction of a competition to
The Economist and Nature (editors), investigate potential genotoxicity
Hershey’s (food), Hewlett-Packard liabilities in small molecule
(computers), Eli Lilly and Roche candidates, the Research Team
(pharmaceuticals), NASA (space expected to realize the following
exploration), PepsiCo (beverage) benefits from Kaggle:
and Procter&Gamble (FMCG) are • Competitive in both cost and
currently partnering with InnoCentive time to delivery
in order to solve their problems. The
• Allows engagement with
InnoCentive community includes an external community of
about 200 000 individuals from more data scientists to create an
than 170 countries, and as of now, awareness around BI as
it has distributed fees for an overall a cutting edge, innovative
amount of 28 million USD. organization
• Reactivity: can almost
immediately deploy the winning
Kaggle Data Science All the Healthcare market players model(s) internally for use by
Competition: a BI case have in common one very relevant medicinal chemists through
study in crowdsourcing thing: they produce data. The Bipredict, or other local
distribution platforms
whole of Healthcare is becoming an
industry based on Big Data. The competition was launched, as
planned, on 16 March 2012. As early
Could be this high end technology
as 22 March there were 74 teams
an entry barrier in the healthcare
comprised of 90 players who had
space? No. Dozens of companies
submitted 277 entries. Twenty-four
are already competing in the
of these entries represent models
massive data collection arena,
that are ‘better’ (i.e. more predictive)
fighting to offer qualified – low cost –
than the best initial benchmark.
analytic tools.
The success of this project
Kaggle – based in California - is a
has been covered in external
good example. Financed with USD
communication via a BI press
11MM, they launched a platform
release and subsequent coverage
for predictive modelling and
in several blogs. Tweets from both
analytics competitions. Companies
@boehringer and @boehringerUS
and researchers post their data.
have garnered >200K impressions
Statisticians and data miners from all
to date.
over the world compete to produce


“ Through the previous paragraphs, it has become apparent that
crowdsourcing, Big Data, and Quantified Self are important trends, which
enable the surge of a revolution about how previously consolidated, but
inherently limited frameworks, like clinical studies, and the development of
new drugs, can happen.
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

Hierarchical models The communication process is also had the possibility to determine
and broadcasting traditionally defined as the passage not only which information had to
of informational units (content), flow from emitters to receivers, but
coded into some sensorial artefact also which information should not be
(language) from an entity which delivered.
produces them (emitter) to another
Also, traditional advertising models
entity with receives them (receiver).
conformed to this hierarchical logic,
Context and channel employed in
in which there is a linear and non-
passing the informational units from
equal relationship between the
one entity or the other are pivotal in
emitter and the receiver, where the
determining the quantity of delivered
latter is passive in terms of acquiring
information and its interpretation.
information. Traditional advertising
When described as such, it is is based mainly on the attraction
evident that communication of target users in predetermined
has historically been interpreted channels; the offering of valuable
as a linear process, in which content to them; and the application
informational flow travels in one of the so-called contextual (printed
direction, and no feedback is paper) or interruption marketing
considered. This philosophical (radio and television). In this
attitude was the cultural substrate respect, the main strategy used by
to the construction of the mass advertisers to ensure their content
communication system, whose was received was the saturation of
media (newspapers, radio and physical (tabular advertising) and/
television) acted as unidirectional or media (press/radio/television)
channels for message delivery from space. This is so that the end user
emitters to target users. The result had a high possibility to encounter
of this model was that the owner(s) the message throughout the day.
of media channels were also the In parallel, within a specific medium
owners of information. Media (like television), the most successful
owners were indeed in a position brands were the ones that had the
to determine the agenda, i.e. the possibility to win the competition
type, combination and frequency of for the most fruitful time slots (prime
information which, delivered from time), i.e. the moment of the day when
emitters to receivers, massively most users were connected to that
contributed to build the audience’s medium/channel. Finally, persistence
knowledge, attitude and opinions of the message, and therefore the
about whatever issue the agenda realization of sales, depended on the
setters felt functional to their own single campaign extended over time,
needs. In addition, agenda setters and frequency of message repetition


within a single day. equivalent of broadcast media, a
large number of representatives
While functioning well for many
using the same materials and
decades, and allowing the surge
delivering the same message to
and fortune of a whole industry
their customers. Pharmaceutical
based on traditional media, this
companies have already been
mechanism has proved to be
moving from this traditional model
progressively less efficient over
using customers profiling to tailor
the last few years. Television in
messages and interactions. This is
particular suffered an extensive
becoming ever easier to manage via
loss of efficacy in terms of
the variety of digital channels now
public adherence, principally
available to reach physicians.
owing to an exaggeration in the
frequency of interruption marketing
practices. The introduction of
These past years have been the The network model
technologies like remote control
testimony of the surge of the digital and P2P
and TIVO strongly empowered
revolution, with the progressive Author: Ferdinando Scala
users against the mounting wave
introduction of technological assets
of advertising slots, and their
and tools that have fundamentally
excessive frequency in the body
changed the communication
of programs. Furthermore, while
panorama. The building of the
still remaining interesting for the
World Wide Web and its mobile
generations which were involved in
development generated a
this system of content broadcasting,
completely new system of relations
television progressively lost its
and communicational fluxes, which
power as a medium especially in
is identified as a “network model”
the younger generations, the ones
which first embraced the digital The network model disrupts the

media revolution and its mobile traditional hierarchical models, by

development. breaking the linear and non-equal
relationship between emitter and
This resulted in the declining
receiver. The receiver becomes an
efficacy of television as a mean of
information selector and also an
sales generation for Fast Moving
emitter, whose influence and impact
Consumer Goods (FMCG), but also,
depend on the extent and depth
in the pharmaceutical field for Over
of his social network. The rate of
The Counter (OTC) drugs. While
disruption is so deep that lexicon
commercial and pharmaceutical
has also changed, generating the
industries started to realize this fact,
neologism “prosumer”, in order to
a growing number of investments
identify a new type of actor. The
were progressively diverted from
term “prosumer” results from the
traditional media to the new digital
merge of the words “producer”
ones.
and “consumer”, and in the specific
The traditional sales force could informational domain, it has the
be seen as the prescription drug significance of “person who is


simultaneously producer and direct colleagues of a GP or the
consumer of information”. People peer Specialists in a Hospital, and
previously known as “target” or generally limited to the immediate
“audience” have been enabled geographical surrounding); to many
by the construction of networking hundreds, in relation to the extent
infrastructures and tools (namely of the virtual network a single
Social Networks like Facebook or individual has, and irrespective of
LinkedIn; or Collaborative Media the geographical dimension.
like Wikipedia) to exit the traditional
In this context, while still maintaining
paradigm, where they were solely
a strong power of influence, the
absorbing information coming from
opinion of Key Opinion Leaders is
hierarchical, unidirectional media;
somewhat mitigated and blurred
and become information emitters
by the possibility for other subjects
toward their nearer peers. It has to
(prosumers) to actively select and
be noted that information exchange
spread information, according to
among peers existed even prior to
their own rules and belief. In this
the invention of Social Networks.
context, the personal relationships
Indeed, a large part of the traditional
among peers (where personal
advertising model was based on the
does not necessarily imply a direct
primary influencing of the so-called
knowledge in the physical world;
“opinion leaders”, i.e. individuals
but is based on the frequency and
who had, because of their
quality of interactions) are based on
standing and power of influence,
trust and credibility.
the capability to spread and affix
in the minds of others messages It is therefore important to

coming from the interested emitters. understand the new rules which

The pharmaceutical world has apply to the new channels, which

always relied on this paradigm, for are much more volatile and

example by passing information immaterial than before

about the new drugs or new
indications, clinical studies and so
We shouldn’t consider this evolved Real time is for
on, to prominent physicians (Key
marketing scenario -where peers marketing (the
Opinion Leaders - KOLs), who
need to be frequently reached Cluetrain manifesto)
assumed the role of interpreters of
with coherent messages- just as a
the pharmaceutical industry’s data Author: Leandro Agrò
fragmented target to address with
and messages toward the medical
a common message. Empowered
community.
HCP and Patients are walking away
What has changed forever with from any kind of broadcast. Today
the advent of Internet and Social the most efficient way to reach them
Media is the fact the number of is joining (or leading) the so-called
people simultaneously reached “Conversation”.
by a discussion about a topic has
As a quick background about the
changed from a few (let’s say the
idea of “conversation”, we should


start from the seminal book “The The Clue Train Manifesto contains
Clue Train Manifesto” (also known as 95 theses that re-defined Online
CTM, 1999). 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
conversation.

What does it mean when one says,
“markets are conversation”?

Authors assert that people
leverage the “human to human”
conversations with companies,
potentially transforming 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 of
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 and how to treat diseases to which
is evolving the whole healthcare we are vulnerable. In just two
market, people can find over the hundred years we have gone from
Internet tons of information about a society suspicious when it comes
any disease, and potentially contact to science, to one centred around
anyone to collectdifferent opinions. science.

The power in the hands of any single
person today, is bigger than the one
Today we live in a world where
available to US President 20 years
private companies such as SPACEX
ago. Today we have the “big picture”
launch into the orbit every kind of

This video illustrates how over the past two
centuries, life expectancy and per capita wealth,
have vastly improved for many nations. Of course
of healthcare at our fingertips. For flying object and where ten percent the current state of health does not mean that
there are no other potential alarms for the planet,
example, today we know that there of the gross domestic product of the BUT if you look at our health, we cannot miss the
has never been a time in the past world’s major economies is spent on underlying declaration of this video that WE ARE
GOOD and have NEVER BEEN BETTER.
when humanity was better off than health. (Source: http://en.wikipedia.
it is today. This video “The Joy of org/wiki/Health_care_industry)
Stats. 200 Countries, 200 Years, In the world of pharmaceutical
4 Minutes” by Hans Rosling (BBC companies, we find examples such
Four) - http://www.youtube.com/ as Johnson & Johnson (the largest
watch?v=jbkSRLYSojo – could of all), which is at 40th position of
suffice to inspire this systemic the Fortune 500 ranking. The size
optimism. of this company is based on its
120,000 direct employees and over
If we are good, well this depends
$60 billion in sales. In comparison,
on many factors, including what
Apple, with its $65 billion and half of
we know today about our health
the employees of J&J, is just above


at 35th position of Fortune 500 (pre-
iPhone5 rankings). Healthcare is moving out of
The comparison - even that of her “Ford” era just as the
wealth – between the consumer- culture of the Internet is
oriented Apple, and J&J or any other growing evermore rampant,
pharmaceutical company, might
and this mix is potentially
seem completely out of place, and
disruptive.
actually for a long time, it was.

In recent years, however, the
mutation of both economic and pharmaceuticals may undergo
cultural dynamics has made drastic changes or even some
comparisons like these more surprising extinctions. This crisis
justified. The need to be more has forced many companies to
efficient and closer to the end return to invest in R&D and by nature
customer, even in the sanctuaries of contemporary approach often
of health organizations, is changing translates into research in the field
from within. of biotech. As a result, the culture of
many companies is moving from a
The digital culture that permeates
“cure-all drug” to “a drug tailor-made
society has changed the needs and
for you.”
expectations of customers, forcing
entire industries to convert to certain A key point of this cultural shift is the
important mentalities or come to change in the almost total access to
terms with the traumatic entry of the medical information base. At the
outsiders. Also, this being 2012, and same instant in which a disease -
regardless of your opinion of the especially if not particularly severe -
Mayan prophesy announcing the affects us, we become transformed
end of the World by 21 December not into “sick people” but into
2012, this is the year in which some ePatients: people who are able,
major players in the healthcare world through the distributed knowledge in
are going through their “perfect the Internet network, to learn about
storm.” their conditions as well as treatment
options, comparing the different
2012 has indeed been labelled
therapeutic approaches and results.
‘annus horribilis’ due to the number
of healthcare patents that are However, one needs to be careful
approaching expiration | Source: and not consider the ePatient |
http://www.pharmatimes.com/ http://en.wikipedia.org/wiki/E-Patient
Article/11-02-03/2012_real_annus_ | as a consequence of technology or
horribilis_for_patent_expiries_-_ an outcome of the Facebook era.
EvaluatePharma.aspx
Dave deBronkart, archetype of the
By 2015, following the expiration ePatient by definition, was the one
of other very relevant patents, who made famous this term with
the ranking of the 50 largest his speech at the TED Conference,


when he narrated this episode: to help save their own lives, and
looking at the opportunities that
That Fall of 1969, the Whole Earth
this change has created, you
Catalog came out. [...] We think of
could say this democratisation and
hippies of being just hedonists, but
consumerisation of healthcare is not
there’s a very strong component
necessarily a bad thing.
-- I was in that movement -- a
very strong component of being ePatients are not the only forces
responsible for yourself. This that are influencing the world of
book’s subtitle is: “Access to healthcare. The entire industry is
Tools.” [...] Tom Ferguson was the affected by new situations. Recently,
medical editor of the Whole Earth in The NewYorker, an article was
Catalog. And he saw that the great published with this provocative title:
majority of what we do in medicine Restaurant chains have managed to
and health care is taking care of combine quality control, cost control,
ourselves. In fact, he said it was 70- and innovation. Can health care?
80% of how we actually take care
The thesis of the author of this
of our bodies. Well he also saw that
article, an employee of an academic,
when health care turns to medical
non-profit health system called
care because of a more serious
Partners HealthCare, is as follows:
disease, the key thing that holds
The Cheesecake Factory, used as an
us back is access to information.
example, is part of the Casual Dining
And when the Web came along,
industry and, present everywhere in
that changed everything, because
the United States, can serve fresh
not only could we find information,
food, cooked on the spot, with a
we could find other people like
growing price / quality ratio to eight
ourselves who could gather, who
million people each year. In attaining
could bring us information. And
this result, they have democratized
he coined this term e-Patients --
access to certain foods for lower
equipped, engaged, empowered,
income groups, and at the same
enabled.
time, they had to influence the
This hippie counterculture note processes of supply logistics and
helps emphasize how seeing the their suppliers, optimizing logistics
ePatient as an insignificant role and processes both internal and
would be a double faux pas. Firstly, external.
since it is an ingrained, long-
This action, which affects the source,
established phenomenon. And
is of course only possible when you
secondly because phenomena that
reach a certain critical mass. The
benefit from digital advancement
process of improving the quality/cost
are rapidly approaching their tipping
ratio of the entire sector of Casual
point: http://en.wikipedia.org/wiki/
Dining, started when the chains
The_Tipping_Point
became protagonists. Now, this
ePatients are motivated and very same change is happening in
prepared to do everything it takes healthcare.


“Medicine, though, had held out blood pressure directly on your
against the trend. Physicians iPhone. http://www.withings.com/
were always predominantly self- en/bloodpressuremonitor.
employed, working alone or in small
From ePatients to the influences
private-practice groups. American
due to changing forces in the field
hospitals tended to be community-
in the value chain, the world of
based. But that’s changing.
healthcare is changing rapidly. A
Hospitals and clinics have been
key player in this change is that of
forming into large conglomerates.
technological acceleration. When
According to the Bureau of Labor digitalization affects one industry,
Statistics, only a quarter of doctors it does not leave it immune to its
are self-employed—an extraordinary actors, or better yet, pulverized and
turnabout from a decade ago, in many ways expands the supply
when a majority were independent. chain, requiring all existing actors
They’ve decided to become to deal with change and possibly
employees, and health systems predisposes it to new opportunities.
have become chains. In medicine, Healthcare is not free from this
we are trying to deliver a range explosive effect of digital and
of services to millions of people ePatients represent the most visible
at a reasonable cost and with a part of this rapid change.
consistent level of quality. Unlike the
ePatients are not aliens that have
Cheesecake Factory, we haven’t
arrived from outer space. We are
(yet) figured out how”
ePatients when we:
http://www.newyorker.com/ • Seek information on the Internet
reporting/2012/08/13/120813fa_ about symptoms or diseases
fact_gawande?mbid=social_
• Seek practical advice via social
tablet_f?share=OIfZ2X networks and share experiences
Similar examples can be drawn related to health

in many areas of the world of • Use self-tracking or wellness
healthcare. Even the area of medical devices because we aspire to
devices is not without drastic feel better

changes. Just going to the Apple • Think of a hospital as a service
Store, one can find many medical company
devices that cost less than a • Look at the tools that doctors
hundred dollars. Just five years ago, use and compare them with
we could find these devices only the technologies that we have
in-house
in a pharmacy and we would have
purchased them only on medical • Look at drugs no longer as
advice. closed boxes accessible only
by doctors, but as products we
One example? Withings Blood use and to which we subject to
Pressure Monitor, for an easy and careful scrutiny before purchase
accurate self-measurement of your


Health industry.
We, in Pharma, can’t drive, As easily understandable, the
over-influence or hide above mentioned trends are not
the global conversation restricted to pioneer attempt toward
ePatients started about a new level for patients to acquire
and share medical information. On
healthcare. We should be
the contrary, it already generated
part, and culturally lead it.
PatientsLikeMe, a very notable
example about how collaborative
attitude can incredibly improve the
• We influence those around us
levels of treatment and quality of life
by sharing our experiences on
of patients.
health.

Some issues published in 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
The World After the ePatients
health apps were downloaded in
2011.”
A bright mind, an anthropologist, a TED fellow, recently discovered that he
In 2011, in terms of earnings, the has brain cancer.
area of mobile health applications
As an artist and freethinker, he decided to publish on the Net all data
reached $ 718 MM. The main regarding his disease. Unfortunately most of the data were recorded in
reason for the significant growth is private data format, hence were not visible and sharable over the Net.
an increase of smartphone users on
What did he do?
the demand side, and the increase
He hacked the data, and published everything on a website. Thousands
of mobile Health applications on the
of people read the data, hundreds of physicians participated by providing
supply side that has doubled since
alternative information and data to him and to the medical staff.
2010.
This Italian ePatient’s story was so largely followed by the media, that the
Many major health care companies Ministry of Health declared their willingness to pass a law engaging medical
have found mobile Health institutions to provide health exams in an open format.
applications as being an effective This is not the end to this story as this thinker – working closely with the
medium to promote and deliver authors of this whitepaper – declared:
healthcare products and services.
“the ‘e’ before the word ‘patient’ is not there to testify technology. This ‘e’
More information on the mobile is there to destroy the word “patient”, usually considered as a subset of
Health application market can be people with inferior autonomy, power and will (as is often the case when
found in the detailed report by someone enters in a hospital).”
research2guidance entitled, “The The Internet is a disruptive ingredient and ePatients will leverage this
Mobile Health Market Report 2011- superpower to stay in the same category as the other humans. The next
2016”, which describes the impact word will be just “persona”.
of smartphone applications on the

FERDINANDO SCALA AND LEANDRO AGRO ON CROWDSOURCING AND BIG DATA IN HEALTHCARE

FERDINANDO SCALA AND LEANDRO AGRO ON CROWDSOURCING AND BIG DATA IN HEALTHCARE

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