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May 10, 2016

LET'S MAKE GOOD HEALTH INFECTIOUS

Cynthia Queano kicked off this last educational event of the 2015-2016 season with a resumé of some attendance statistics. Overall, there was a 14% increase in attendance since the beginning of the season, and there was a whopping 40% increase in attendance at the holiday 5 à 7 dinatoire event! She also mentioned that Abbvie is a new PMCQ educational partner and Shannon Quinn will be the new PMCQ president next year.

The speaker for this event was Dr. Mike Evans, a physician at St. Michael’s Hospital, an Associate Professor at the University of Toronto and a Lead of Digital Preventive Medicine at the Li Ka Shing Knowledge Institute. The premise of Dr. Evans’ lab is to create high quality, infectious health media that engages the public and encourages “peer-to-peer healthcare”. One of the outputs from his lab is Dr. Mike’s whiteboard series, which has been seen by over 12 million people on YouTube. Dr. Mike’s presentation was entitled, “Changing Clinic. Changing People. Changing Yourself.” He began by saying that he encourages people to be more creative in their worlds and to think of unusual solutions.

He said that, historically, patient education has been about telling patients what they already know. He felt that the public is a group that could be engaged more. He pointed out that two-thirds of healthcare problems are solved at home, through patient self-care, self-prevention and self-management. However, everyone is different and everyone has different ways of understanding, meaning that teachable moments vary from one person to the next. For example, there are different “groups” of people, such as “proactive holistics” who are proactive about their health, but there are also passive people who need to be nudged. What might fail with one group might work with another, in terms of marketing “nudges”.

Dr. Mike also spoke about social media and how it can be used to deliver clever, simple, story-driven health messages. He gave some examples, one of which was Donald Low, a famous infectious disease specialist, who developed a painful brain tumor and he wanted physician-assisted death. His wife videotaped him and the video was released by the CBC, and within 10 days, it was a front-line item on policy-making. Dr. Mike said that the story-fication of such matters produce “I get it” moments with viewers.

He mentioned the results of a study of 20,000 Swedish men that examined the effect of five lifestyle factors on the rate of myocardial infarction (MI). If the men incorporated all five factors into their lives, the rate of MI was reduced by 80%. However, only 1% of the men incorporated all five. Dr. Mike said, “We focus so much time on getting a 6-pack, but we’re just trying to get 1-pack under 75 inches.”

Dr. Mike also spoke about his video entitled “23 ½ hours” which identifies “sitting disease”. Most people spend most of their day sitting, and this “disease” has become a worldwide phenomenon. The point of the video is to promote a half an hour of exercise per day, which provides a multitude of health benefits. He then showed snippets from another video his group created called, “Make your day harder”. This video focuses on the health of baby boomers in comparison to previous generations, showing that they have more chronic disease, obesity and lower self-rated health. He said that younger generations have more severe cases of “sitting disease”, because technology has stopped them from being active. For example, shopping online instead of walking to stores. Dr. Mike wants to start an “anti-pushing-the-button movement” and encourage people to “tweak their week” by taking the stairs, riding a bike, or having a walking meeting instead of conference meeting. He quipped, “Park farther away in that spot for people who want to live longer.” There is also a Make Your Day Harder website (www.makeyourdayharder.com) that has excuse “personas”, including Tired Tina, Busy Brian, Nervous Nina, Just Don’t Wanna Jonah, Full of Good Intentions Family and Ailing Ali. The website is full of good suggestions to overcome these excuses and get people moving more.

He pointed out that there is an architecture to behaviour change and people need to think their architecture is in order to change behaviours. He encourages people to take baby steps, by looking at their week instead of their life, and making small changes rather than big ones. For example, people need to be aware of their eating tendencies in order to change them; are they grazers, “all or nothing” eaters or nighttime nibblers? He also emphasized that consistency is a more realistic goal than perfection, and people can make the right decision in moderation.

Dr. Mike then provided some tips on peer-to-peer healthcare and engaging the public. He provided the following advice:

1) Be engaging enough that people will share on their social media or community

• He gave examples of things that he has done that proved to be engaging
  • Low literacy comic books about breast cancer and diabetes
  • His self-funded 23 ½ hours video, which was not sponsored by pharma or any other health institution; it was designed to be “medical school for the public”

2) Capture the wisdom of patients

• The psychosocial support of cancer patients could be done better, so he and his group spoke to patients and asked them to reflect on the challenges they’ve encountered, such as body image, telling kids about a cancer diagnosis, etc.
• He showed a video he’d done with a patient who had breast cancer that metastasized to her brain and how she dealt with it, telling her family, etc.
• Patients are incredible treasure troves, especially in embarrassing diseases like bowel cancer, etc.

3) Create or curate?

• There is a lot of information available to fuel ideas and help identify information gaps
• Can weed out the best information that’s relevant to patients and incorporate it into your own social media
• Clinics can set up “fan” pages; posts can be boosted from these pages

In summary, he emphasized the following key points:

• Consistency rather than perfection
• Be curators and use existing platforms
• Social media can have an impact
• Embed stories in relationships of care
• Build community
• Move quickly
• Use technology

Dr. Evans then answered questions from the audience, a summary of which follows:

Q: What could pharma do differently to have an influence on patients and patient health?

• Using CME and KOLs to drive products into guidelines or scope of practice is “old school”
• There are interesting opportunities around innovation and the concept of “hacking health”
• Create an environment in which clinicians can learn from others
• Develop a design school for healthcare; shoot a film about a patient that includes whatever they want to talk about, add some graphics, post it on social media, do a podcast, build a website within a day and send patients to it
• Every practice has people in it that would like to build creative things; find them and harness their capabilities
• Pharma is going to have to figure out transparency and create trust; disclose that you are part of something from the beginning

Q: If you had to look back and reflect on your journey, what was it about the whiteboard concept that resonated with people?

• We just got lucky with one product and went after it
• Everything was about educating patients, residents and getting research dollars
• There are not a lot of YouTube educators in the medical arena, so we went after that

Q: What about communicating with patients in non-traditional channels? Where will this be 5 years from now with general medicine?

• Prescribing apps will likely crash
• Why aren’t patients getting graphical lab/test results in an easy to understand format? Visualizing information for patients should be done, as it could help with behavioural change

Q: We are marketers trying to reach all physicians across Canada. KOLs don’t operate the same way as GPs. How many physicians are practicing “virtually” compared to a few years ago?

• Most physicians would say they’re doing some form of email clinic, but there’s no financial incentive for them to do it
• I would take KOLs who are already doing email clinics and figure out funding or back-channelling for this and then shine a spotlight on them and have them share their experiences
• Little pearls or “tales of caution” are important

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Lara Holmes
Medical Writer
Email: lholmes@videotron.ca
Cell: 514-425-4977

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