As given to the Drug Information Association on the wisdom of crowds

    An honor to be here.

    I have known many of you as friends and by reputation over the years

    It is not “in” to say this – but you save lives in what you do – it really is an honor.

Today I will make a presentation by not making a presentation.

No slides, no visuals, no studies, no data-filled chart.

I will take it for granted everyone of you, or every one of your kids, spends more time in social experiences on line or on mobile devices than any one of us cares to admit.

So the headline is simple and needs no bar graphs:  social media is big, and it’s here to stay.  Nothing to write down today; nothing to cheer, nothing pithy to tweet — let’s move on.

I’ve spent more of my time of late, instead, trying to figure out what it all means – for society more broadly, for health closer to home – and I’m not sure I have any conclusions either, but perhaps a few reflections that may be of some value.

I was psyched a few weeks ago to attend a Washington Capitol’s hockey game – the first in a few years, and one of the last before their untimely demise to that evilness that is Boston.

The crowd – like a hockey crowd – was loud, emotional, many covered in face paint, others in wigs, still other seemingly pleasant Washington Lawyers and lobbyist banging on the glass with the hope – I really think – of getting their well manicured hands around the throats of one of the opposing players.

It dawned on me, with not too little trembling, that whomever came up with the term “wisdom of crowds” had never been to a hockey game.

And yet…   And yet,

I live most of my life now around different forms of “crowd” sharing of information – for my news, for recommendations for almost anything I buy or eat, or visit, for – well – wisdom.

In fact, for all the many fears of unleashing people’s experiences, insight and bile — the social web has shown that the ability to aggregate many experiences and reflections is 1) extremely effective and 2) very self policing.

That the fears, while sometimes real, are overwhelmingly outweighed by the benefits.

That the powers of speed and transparency uncover a good deal of naughtiness and outright evil.

That counsel of any one person may be terrible, irresponsible, even dangerous – the experiences of those who have “been there” in aggregate can be life transforming.

That the capabilities unleashed by technology is less about the technology, and all about meeting basic human needs men and women have shared forever:

    To miss nothing on issues that matter to us
    To even have a little insight no one else has
    To connect with the precedents, experiences and people who go through what we go through
    To be able to act upon this knowledge with some comfort that life can be better
    To feel that our opinion matters, our voice is heard.

It is equally unsurprising, then, that anyone and everyone who can would rally around the ability to aggregate wisdom, to aggregate our own truths — from multiple sources, multiple connections to and conversations with people.  It is as predictable as the sun setting in the west.

We have always done this anyhow.  Only now, it has never been more easy, efficient, and specific to our own individual.

There are four kinds of wisdom of crowds:

1. The wiki-approach — many people speaking/editing/voting
2. The influencer approach — privacy-safe, aggregate wisdom that helps guide decision making — Amazon’s those who buy this, buy that.
3. The data approach – significant aggregation of actions, or votes up and down and reviews for a service.
4. The experiential approach – people sharing their experiences, what one reads, what one does — on my terms, not just in a broad sense, but literally down to what I want to know from people who look, act, been through what I’m going through.

And this wisdom has exponential, even life-saving ramifications in health.

We all know in the off line world, there is certain value we get from the woman and man in a white coat;  that there is a very different kind of  support and love and help we get from family and loved ones, not just in our backyard but anywhere;  and unique guidance from those who have been there.  It is unique.  It causes a binding experience with that person and with their “wisdom or content.”

Making these connections borderless, timeless, and on our terms answers not only the basic human needs I mentioned before, but three additional ones distinct to health seekers:

  I’m not alone
  I’m not crazy
  Actions taken by people like me matter

It is the last one in particular that is revolutionary, and what is real — not hype — real empowerment.  I know I can take control or act in a certain way because someone like me did, and succeed.  Again, not just my condition – but ME!  I see this on the health central sites daily.

  A 32 year old woman with breast cancer.

  An ADD adolescent who thinks he’s a loser

  A depressed husband who doesn’t know how to answer his wife’s constant, “what are you depressed about?”

  A 55 year old man asking, “should I put my Dad in a nursing home”

Shared stories; shared aggregate data of what works or doesn’t; shared recommendations – all equals better outcomes and greater individual control.

I have had many epiphanies being in and around the health world over the past few years, but perhaps the greatest of all is how much has been beaten into our DNA that health decisions are made by someone else.

Your company chooses your insurer, they push you towards a doctor, a doctor pushes your action after a 12 minute consultation.  I exaggerate but not by much.

In the crowds one learns that others just like you regularly fire a doctor, get a second opinion, come back from a drug holiday, talk to a boss about health needs, learn how to tell their children about what they are going through, try a new course of treatment etc.

Do bad things happen in this wisdom, is bad counsel given, is data sometimes flawed?

Sure.

But I was recently in one of the best hospitals in the world with outstanding doctors for a minor procedure, and was nearly killed by the pneumonia I contracted when the procedure went amiss.

This is life.  We all lose in the end.

In the meantime, at our finger tips, is unprecedented access to tools of transparency and decision making.  People will live longer and better live due to it.

Industry, of course, doesn’t know what to do with a world they cannot control.  Some businesses wish it away.  Others focus on the bad elements, as if hoping fear will force it away.  Still others simply play lip service.

But the pendulum of history has shifted to the individual.  Ignoring or fighting it will fail.  Paying lip service will miss opportunity to push beyond our own agendas.  I will tell you that the answer of engagement is not in trying – like the old days of marketing tried to do – to interrupt, annoy, brow beat, swamp people to do what you want them to do.

The rudder of the boat in the waters of social wisdom is to simply be on their side, offering insight on their terms – to, in fact, be the patient we seek –  and let the rest take care of itself.  I’ve met every twitterer of every pharma company, I believe, in the US.  And not one told me they would follow themselves if they didn’t work at that company.

That says something.

I am neither an apologist nor a cheer leader for the worlds we live in.  I try to be, anyhow, an idealist without illusion.  There are dark sides here.

For me, the darkest side is one that surprised me – though if I were half the human behaviorist I think I am, I should never have been surprised.

Back when I ran the online sites for the Washington Post and Newsweek, I was almost giddy with all the information available to everyone.  We’d all learn from each other, all hear each others’ views, we’d be a better informed society.

But then I saw a small study – Berkeley I think – of a guy who researched buying behaviors on Amazon.  He wondered how many conservatives buy “liberal books” and vice versa.  Putting aside that one can debate what makes for a conservative or liberal book, the findings we startling.

Well over 95% of each read only their own views.

Ours could be, is becoming, a world of self-confirming crowds and biased wisdom.  This concerns me profoundly.  Ask yourself what news channels you watch on television, what perspectives you seek online.  It may give you pause.

Twitter, which I adore, I think has compounded this.  140 characters is a great way to share what others I admire are reading at any one time, but they lend themselves to the angry, and snide.

And the quick, biased wisdom rallies not only opinion, but action.   Anyone hear yet of the “money blurt?”  It is one of the most effective fund raising vehicles in politics right now.  Post an incendiary remark, and link to a donation.  The crowds pass it around like lightening.  One candidate just took in $ 1 mm on this tactic alone.

This is worthy of watching and checking aggressively – because the desire to have one’s thoughts confirmed is also very much a part of the human condition.  If you think this is only about politics, keep in mind that it is in this environment that the cacophony that was healthcare reform was played out – that any sensitive issue, stem cell research, end of life care, circumcision, diet and fitness – are all now being debated and shared.

As Henry Drummond, that vaguely fictionalized Clarence Darrow in the vaguely fictionalized “Inherit the Wind” noted progress always has a price — “Mister, you may conquer the air but the birds will lose their wonder and the clouds will smell of gasoline.”

Individuals need to constantly seek views from outside their comfort, and hold themselves as well as organizations and data accountable and transparent – that is a price.

Businesses need a thick skin to face the wisdom of the crowds – that is a price.

Businesses need to shift their paradigm that being of service to peoples aggregation of wisdom is as valuable in the end as trying to compel them to act on their own agendas – that is a price.

Regulators – overworked, under paid, under resourced, patriots to a person I have met – need to appreciate that these aggregations and conversations are happening anyhow – and that to engage is actually a small price.

To make easier business engagement in these environments on individuals’ terms really isn’t that much different than what happens in the traditional worlds – no one would penalize a marketer for advertising around an Oprah guest who mentions an adverse drug interaction, so why keep them from engaging in crowds and conservations.  They are, in fact, the ONLY regulated contributors to that wisdom!?

Transparency.  Openness.  Shared Experience.  Shared Wisdom.  These are revolutionary and unsettling terms.  But who among us don’t want them for ourselves?  Who among us have not sought them pre internet.

Is it that hard to be the patient we seek?

We all, and or our loved ones, are patients at any given time.

Arthur C. Clarke famously noted that “Technological revolutions are most often OVER estimated in the short run, and UNDER estimated in the long run.”

The long run is now.  The time to embrace it is now.  It is happening anyhow.

And I, for one, however, will only watch hockey on television from now on…