AMA vs. Photoshop: think of the children

This pic is everywhere now

Last week the American Medical Association officially condemned the "photoshopping" of models in fashion advertisements and magazines to make those models appear unrealistically thin.  While the "models are too skinny" debate has gone on for decades, this is a rare and important step.  Their stance is obviously more of a statement on our runaway culture of beauty than our use of technology, but it also should send a clear message to those of us in the communications business (marketing, advertising, or PR) - just because you can do something, that doesn't mean you should.  Earlier this month I warned against pretending to be someone you're not. This is a similar principle - don't use deceptive images to promote your products.  This example demonstrates the consequences can extend beyond looking like a creep.

I'm not going to pretend to be the moral authority on these issues and I'm not going to say it's wrong to retouch a photo or get a nip and/or tuck if you want.  However, it seems the AMA believes things are getting worse, not better - and it's clear that technological advancements have enabled some people to take things to the extreme.

This issue reminds me of two other issues where some segments of the medical community have already weighed in but I wish the AMA would add its rather hefty and credible voice - promotion of breastfeeding and reducing the influence of pro-anorexia groups on social networks.  I've written about this before. People who freak out over nipples on breastfeeding pictures in Facebook profiles aren't simply advocating for more modesty, they're reducing our ability to promote breastfeeding - and that has negative health consequences.  Social networks like Facebook have made some progress on cleaning up pro-ana sites, but they're still around - and this is also a threat to public health.

Don't take my word for it - take my wife's.  She's the health researcher at the big-time university, and she wrote about both issues several years ago. Discouraging breastfeeding is bad.  Facilitating the harmful practices of people with anorexia is also bad. Of course, I look at the Facebook terms of service and I don't see anything in there that would address these issues. I'm not sure if other social networks have different terms.

Bottom line, there's an opportunity here for the AMA to get more involved in the online space. There's no question that our culture affects our behavior, and our behavior affects our health.  While we should be mindful of protecting free speech rights, we should be giving the medical community a larger voice here.

There are so many things wrong with this I barely know where to start

OK, not a social media thing but I saw this in Tuesday's Washington Post and I'm flabbergasted:

When a drug to prevent babies from being born too early won federal approval in February, many doctors, pregnant women and others cheered the step as a major advance against a heartbreaking tragedy.

Then they saw the price tag.

The list price for the drug, Makena, turned out to be a stunning $1,500 per dose. That’s for a drug that must be injected every week for about 20 weeks, meaning it will cost about $30,000 per at-risk pregnancy. If every eligible American woman were to get Makena, the nation’s bloated annual health-care tab would swell by more than $4 billion.

What really infuriates patients and doctors is that the same compound has been available for years at a fraction of the cost — about $10 or $20 a shot.

Oh, it gets worse. I've probably pushed the bounds of fair use here so I'll just let you go to their website to read the whole thing.  But please read it, because it's as profound an indictment of our system as anything I've ever seen.  SO, let me see if I have all of the factoids from this story straight:

• There's a drug that the FDA just "approved" to help prevent premature births.  That's the good news.
• A full course of the drug costs $30,000.  And most moms in at-risk pregnancies don't have that.
• A full course of "the compound" (i.e., the same drug) has been available for about $200 to $400.
• Along with FDA approval, the company also got a patent and sole rights to manufacture "the compound."
• Which means it's now no longer available for $200 to $400.
• The company that now owns the patent says it's charging that amount to recoup the costs for FDA-mandated clinical trials. 
• The leading advocacy groups and medical specialists were apparently surprised by the new price.  Seriously.
• The "main study" to prove the drug's effectiveness was apparently an NIH (i.e. taxpayer) funded study, but the taxpayers receive no return on this investment.

Again, from the article (sorry):

A form of progesterone known as 17P was used for years to reduce the risk of preterm birth, but it fell out of favor after the manufacturing company stopped making it. In 2003, the NIH study showed that 17P could cut the risk of preterm delivery if given in the first 16 to 24 weeks of pregnancy. That led to a resurgence in the use of 17P. Because no companies marketed the drug, women obtained it cheaply from “compounding” pharmacies, which produced individual batches for them.

Doctors and regulators had long worried about the purity and consistency of the drug and were pleased when KV won FDA’s imprimatur for a well-studied version, which the company is selling as Makena.

So this company basically did some research to verify the safety and efficacy of a drug that people were already using but either did or didn't already have FDA approval.  And here is where it REALLY gets weird:

In an interview with The Washington Post on Friday, an FDA official said that, if requested, the agency could approve a lower-priced generic version of the drug for another use that doctors could prescribe “off label.”

In addition, the official said the agency would not prevent compounding pharmacies from continuing to provide 17P unless patient safety is thought to be at risk.

“We have our hands full pursuing our enforcement priorities,” said the official, who spoke on the condition of anonymity because of the sensitive nature of the issue. “And it’s not illegal for a physician to write a prescription for a compounded drug or for a patient to take a compounded drug. We certainly are concerned about access of patients to medication.”

So an unnamed FDA official is telling the Washington Post that they could approve a generic drug that would be prescribed off-label?  And they won't enforce the company's right to market the drug as the sole provider - a right that FDA itself granted - because they're too busy?

If by the FDA's own admission it's ok to prescribe drugs off-label, then why do we have an FDA in the first place?

So, to sum up:  our systems of drug approval, intellectual property and taxpayer-funded research have taken a relatively well-known and commonly-used drug that cost about $300 and made it $30,000 for the next 7 years.   It costs that much because now we really know it's safe and effective - after all, this company and the taxpayers have invested millions to make sure.

Of course the company gets a financial return on its investment but the taxpayers don't.   But then again, the company loses too - because the company that invested its own money and time in creating this drug will now have to compete with a gray market that the FDA tacitly condones.   And that's because the FDA has anonymously suggested to the Washington Post that patients and providers ignore the very reason we created the FDA in the first place - making sure drugs aren't marketed or prescribed "off label."

SO....

Compounding pharmacies can look forward to lawsuits from the company that actually got FDA approval.
The company that got approval can look forward to ridiculously bad publicity - even though it played by the rules.
Moms with at-risk pregnancies now get to choose between: a) that worry in the back of their mind that the medicine they're getting isn't really FDA approved or b) a $30,000 price tag
Someone at the FDA gets to explain to his or her boss why they just undermined the mission of the FDA in the Washington Post.

But hey, lawyers and PR guys are probably gonna get paid, so it all works out.

The Day I Became an Environmentalist

This post is my contribution to sustainablog's Pedal-a-Watt Powered Blogathon this weekend. The long-running green blog (and new green shopping site) is publishing for 24 hours straight to raise funds for the Dancing Rabbit Ecovillage in Northeastern Missouri. Go join the fun: read post contributions from around the green blogosphere, leave a comment to be entered in a drawing for some great green prizes, and join in the Tweetchat at #susbppb.

I'm not what you'd call the granola-crunchy type. I don't drive a hybrid, I don't look for organic cotton, I'm not a vegetarian, and most of the time I even leave the water running while I brush my teeth. (I'm trying to stop that.) I am, however, an environmentalist - at least in the sense that I understand that smarter choices lead to healthier, more sustainable lives.

"Environmentalism" has been a big deal in my family for a long time. When I was in high school quite some time ago, my mom would take me to town meetings about the possible siting of a sewage treatment facility in my town, and she told me that trucks with chlorine gas could be driving through the town, and if something happened to one of those trucks it could be very, very bad. It was all very important, but it was also very abstract - these things weren't happening yet, and I never thought anyone would allow a system where an entire town gets wiped out because a truck turned over. The treatment plant got built, but the trucks with the chlorine gas never materialized, and frankly not many people are all that upset about the whole thing anymore.

The light really switched on for me in my first week as "assistant to the Chairman for special projects" in the Department of Pediatrics in what was then called Boston City Hospital. The Chairman was a great guy named Barry Zuckerman. In addition to being this amazing physician and researcher, he just "got it" - he understood that a child's health is affected by dozens of things most doctors can't address.

Barry may be best known for developing the model and co-founding the Reach Out and Read Program, a "nonprofit organization that promotes early literacy and school readiness in pediatric exam rooms nationwide by giving new books to children and advice to parents about the importance of reading aloud." But what did it for me was another project he started with a lawyer named Josh Greenberg called the Family Advocacy Program. It grew into the Medical-Legal Partnership. Josh and Barry told this great story.

Doctors were seeing young children from housing projects show up in their clinics with some pretty nasty asthma. We all know that environmental factors such as allergens and pollution can exacerbate the symptoms of asthma, so in addition to prescribing medicine the doctors would tell the parents about not smoking around the kids, limiting exposure to cats or dogs, and so on. Still, the kids would come back, far too often, with terrible symptoms of asthma. Eventually they discovered that housing projects were carpeted, and those carpets had gotten wet, dirty, and moldy, and the mold was triggering asthmatic attacks.

Of course, a doctor can't prescribe removal of a moldy carpet in a state-administered, federally-funded housing project. And that's where Josh came in. He would navigate the legal bureaucracy to get things done. It was typically a bunch of inside-baseball stuff - it's not like you need to stage a rally decrying the evils of "Big Carpet Corporations" - but it meant a lot to the children and families affected by it.

In truth, the carpet story was just one of many things they did, and I never got the impression that Barry or Josh saw themselves as environmental crusaders. They were child advocates. Barry recruited tons of people to work on dozens of innovative ideas that could improve the health of children - the Child Witness to Violence Project comes to mind. I was really just along for the ride for a few years.

But I never forgot that story about the carpet in the housing project. I understood, in concrete terms, the public health impact of changes to a specific environment. I saw it again in the winter when the hospital's Failure To Thrive Clinic reported children were malnourished and losing weight because low-income parents were using some of the meager food budget to pay for heat.

Why is this story relevant now? Simple. In December the US Environmental Protection Agency announced a determination that greenhouse gasses are a threat to public health, and the agency asserted its authority under the Clean Air Act to regulate the emission of those gasses. The EPA has started a fairly gradual process of data collection and is considering next steps. This action has led to an uproar among the largest emitters of GHG's and their supporters.

But it's really not that far-fetched to suggest there are significant (if unintended) public health consequences to the things we do, and it's not all that bad if people outside the traditional health care profession take meaningful steps to address them.

My friends over at sustainablog are going to be at the eco bed & breakfast The Milkweed Mercantile throwing a blogathon to raise money for Dancing Rabbit Ecovillage. One of the longest-running blogs on environmental issues, sustainablog also recently launched an eco friendly products comparison shopping site, selling everything from green cleaning supplies and organic clothing to energy efficient appliances and composting toilets.

The blogathon will raise funds to support residential learning opportunities at Dancing Rabbit in organic gardening, natural green building, and wind and solar renewable energy design and installation. Interested in checking out Dancing Rabbit for yourself, or taking advantage of some of their educational opportunities? Read more here. And consider making a pledge to support this sustainable community's efforts.

SING

and enjoy your weekend.

Speech Clouds: Health Care

President Obama has finally given his big speech on health care reform. As we've come to expect here, thanks to Wordle this is the text cloud of his speech:

And in the interest of fairness, here's the text cloud of the official Republican response, delivered by Congressman Charles Boustany (R-LA), a doctor:

Not surprisingly, the President is mentioning "insurance" while the opposition Congressman is mentioning "cost." Those are driving the discussions on either side of the aisle.

There was one moment during the President's speech where I like many others was taken aback. Politico reports that Congressman Joe Wilson (R-SC) shouted "You lie!" at the President when the President was debunking false claims that reform would "insure illegal immigrants."

First of all, and it's sad that this has to be said, factcheck.org agrees with the President and not the Congressman. But another line was crossed tonight - perhaps just a line of decorum, but I think more than that. At least one member of Congress now thinks it's ok to heckle the President of the United States during an address to a Joint Session of Congress. He didn't just disrespect the man, he disrespected the office.

It's beyond shouting down the woman in the wheelchair. Once again it's an appeal to the worst in people - heckling the President in support of an obvious falsehood with unquestionably racist undertones. And even worse, to those who oppose reform this kind of thing is USEFUL. It's a distraction. Once again we're talking about something other than health care reform.

I sound like an old civics nerd, but I remember a time when there would always be people in the other party with whom you could reason and negotiate and find a way to do the right thing. I'm left wondering who that is in the GOP today. I'm pretty sure it's not Congressman Wilson.

And there are people in Washington who WANTED this

Seriously - there are people who planned for this outcome, who told lies to work people into a frenzy, who appealed to the worst in us, who felt that this outcome served their interests best. This is what they wanted. And they want more of it. Where there is discussion and debate, they want to bring noise. To literally shout down the lady in the wheelchair.

How does one negotiate with people who plan this?Again, this is a disgrace to my profession - we're supposed to encourage and facilitate debate, not shout it down - and a disgrace to our democracy.

A long time ago I was actually an elected Town Meeting member, in my New England town. Things got a little rowdy sometimes, though nothing close to this. And everyone - EVERYONE - got to say their peace without ever having to worry about hecklers.

What a perversion.

Senator Kennedy

The news of Senator Kennedy's passing is not unexpected but still sad. Right now I suspect the Kennedy family is doing what it always does at times like these - coming together, relying on each other for support, and remembering all the good times while resolving to carry on.

Those of us who worked for Senator Kennedy are reaching out to current and former colleagues, thinking of our proudest or funniest moments with him. I was a mid-level policy wonk at best; but I was there long enough to see how hard Senator Kennedy worked, how much he truly cared for the issues, and how he could be larger than life and profoundly personal at the same time.

I'm sure an avalanche of eulogies for Senator Kennedy will come today and tomorrow; I'm sure people will have plenty of good things and bad things to say about him. I was by no means his closest confidant or his most trusted staffer, but I'm completely certain about one thing.

Right now, Senator Kennedy wouldn't want us to be talking about him.

Right now, Senator Kennedy would want us to be talking about health care reform.

Bloggers are Leading the Health Care Debate

It should come as no surprise that the White House is reaching out to political bloggers to help them carry their message on health care reform - after all, Left Blogistan was instrumental in getting the President elected, and it has demonstrated an ability to mobilize activists and raise an enormous amount of money. Liberal bloggers have also written extensively on the topic, with great detail about the particulars of competing proposals. Ezra Klein, who has gone from his own blog to the American Prospect to the Washington Post, is widely regarded as the wonk di tutti wonks for the left on this issue.

Not to be outdone (though I'd argue they're getting creamed right now in social media), the right has its blog outreach ideas as well - a great example is former Governor and presidential candidate Mike Huckabee posting at Red State on the issue. I think the problem Republicans have right now is they don't have a consensus leader, and historically their communication strategy is top-down, so they're experiencing the growing pains of adopting group discussions. They'll get there.

The thing to keep in mind, however, is that online political communities are relatively isolated - they show up well on social media tools like Technorati because they link to each other, but as I demonstrated earlier, the big political stories just don't register when compared to, say, pop culture. Talking to political bloggers will definitely have some impact, but it's really about "mobilizing the base."

Health care is a different animal - everyone has an opinion on it. Everyone is touched by it. And suddenly mainstream journalists have tucked away their criticisms of bloggers as crazy people who live in basements - now they invite them on television. For example, my friend Dr. Val Jones and her team at Get Better Health have done an outstanding job talking about health care, health policy, and reform - and they're getting noticed.

I was particularly struck by a speech Dr. Kevin Pho gave at the National Press Club. You may know Dr. Pho better as KevinMD. That's right - a doctor from Nashua whose real claim to fame is his blog is now giving speeches on health reform at the National Press Club. His speech struck a chord with me because I worked at the hospital he cited in his speech, but more importantly, he's discussing one of those non-partisan but incredibly important issues facing reform that just seems to get lost in the soundbyte-driven, substance-free rhetoric that currently dominates the political debate. GO READ IT.

I'm really thrilled that health care providers are leveraging social media to make such solid contributions to the reform debate. It's a significant step in the right direction. But it's just one step. Doctors are having influence with political types, but they're still a relatively isolated community online - doctors speak with doctors and only a small handful of others online. (There are a few exceptions, but frankly not many.)

A bigger step will be when government officials reach beyond their comfort zone of ideologically-compatible political bloggers and have meaningful conversations with the community that is, IMHO, the most influential and important online community today - moms.

This community is much, much bigger and much more diverse than the political folks or the medical community. There's really no comparison. A handful of the conversations there are ideological, but you just can't BS mom with the rhetoric we see today. The questions you hear from moms are grounded in real-life experience; they're not focus-group tested or necessarily designed to provoke. The values in this community are important - everything is about mutual respect here. You can be snarky without being uncivil. You can disagree over one issue and still have friendly discussions about something else. There just isn't the "us versus them" mentality you see in the political blogosphere, and while the doctors are trying, the conversations are just much more accessible and inviting.

There are two panels at this week's BlogHer conference that focus on health issues. I don't know if anyone will raise the health care reform proposals currently winding their way through Congress there, but I know it's been discussed in too many mom blog posts to link to here.

Another important thing I'd like to see is better integration between the medical online community and the parenting online community. There are some inklings of hope there - but that's a post for another day.

Best Blog EVAH - Health Disparities Blog at Case Western Reserve University

I found David Porter on Twitter one day and noticed he made a lot of comments about health disparities - something my wife studies in earnest. Turns out he's a Research Project Associate and webmaster for Case Western Reserve University's Case Center for Reducing Health Disparities.

And he puts together an impressive blog.

It's not overwhelming or too shiny; it doesn't suck up bandwidth by throwing a bunch of widgets or huge graphics on the page. It does use some of the basic social media tools that you'd look for in a blog - a really strong delicious links page (you'll notice the blog depends rather heavily on it), some aggregator tools, an RSS feed. You can find some multimedia content (podcasts) in the sidebar and a small but adequate blogroll.

The best thing about this blog is the technology doesn't get in the way of the content. This is a strong example of social media supporting a positioning strategy - it collects some of the best thinking on health disparities and presents it in an accessible way, placing it under the "brand" of Case Western Reserve University. CWRU doesn't necessarily have the reputation of an Ivy League school or a huge land grant school, but tools like this help establish its credibility in a very important - and arguably undervalued - niche. I now know one of the best places to go for information about health disparities is Case Western Reserve University, and journalists looking for a source or notable quotable can go there as well.

My wife mentioned she'd like to see more there on rural health disparities, and I'm hopeful that can be remedied...

Beyond Bizlex: Working Locally, Serving Globally

My latest contribution to Business Lexington features Dr. Wendy Baldwin, the former EVP for research at the University of Kentucky and the current director of the Poverty, Gender and Youth program at the Population Council.

The Population Council is the world's premiere organization conducting biomedical, public health and social science research on population issues. They have offices in 18 countries and programs in more than 65 countries. They don't get a ton of publicity but they do important work, and they deserve much more attention.

I actually met Dr. Baldwin on a plane - coming home from a trip to the DC office a while back. She was "commuting" home as well - her office is in New York while her home is Lexington. She struck up a conversation with me and as we got chatting I thought I had a nice column idea.

As always, the column format is a nice way to express a thought but it doesn't tell the whole story. I'll share the Q&A of my email interview with Dr. Baldwin in the near future.

Moms Taking Care of Families, Taking Care of Each Other

"Blogger outreach" to moms is a lot more interesting and important when you're not trying to get moms to buy anything. It's even better when you're discussing the things moms care about most.

Recently I had the privilege of working with Families for Depression Awareness, a non-profit organization founded in 2001, and Parent Bloggers Network on a small outreach project designed to introduce FFDA to bloggers everywhere.

Sadly, it seems the timing couldn't be better. If you've kept up with the mom-o-sphere at all, you know plenty of people are not happy.

So we threw together a quick survey to get a discussion started. It's not scientific, but it was still interesting. Thanks to PBN, 137 bloggers responded.

About 3 out of every 4 bloggers who responded agreed or strongly agreed with the statement "I'm so busy taking care of my family's emotional needs that I don't have much time to take care of my own."

More than 60% of the responding bloggers said they hide their feelings because they think their kids will be hurt in some way if they see mom reacting to stress or depression.

And 1 out of 4 bloggers said they wished they had the courage to ask for help for themselves or someone in their family. About half said they wanted more information about available resources.

This is all sad, certainly - but to be candid, given the times it's not that surprising.

What struck me, however, was how much these moms rely on their online community - perhaps even more than the people in closest physical proximity to them. About 60 percent said the blogosphere was where they went to find support from moms with similar challenges. And nearly 9 out of 10 people who participated said they feel as close or closer to the people they talk with online as they do the parents in their own neighborhoods.

Then we asked a few of the people who responded to the survey if they'd be interested in speaking with some people from FFDA. They help families recognize and cope with depressive disorders to get people well and prevent suicides. They try to reduce the stigma associated with depressive disorders. And they try to unite families to help them heal and cope. Julie Totten, the President and Founder of the group, spoke with all the moms. From Julie's public bio:

In 1990, Julie lost her brother, who was undiagnosed, to suicide. A year later, after learning about depression, she helped her father get diagnosed for this condition. Julie recently formed Families for Depression Awareness to help others understand depression and reduce stigma associated with the condition.

We also included Dr. Myrna Weissman, a pioneer in interpersonal psychotherapy, on the call to provide an additional level of perspective from an expert. (Sorry Stefania, I know you're asked to talk with "experts" a lot but hopefully you'll agree this is one worth listening to.) I hope the moms who talked with Julie and Dr. Wiessman got something out of the discussion but they will speak for themselves.

Again, the survey is not scientific - but it does make you think. Perhaps the mom-o-sphere isn't just a place where marketers ask women to talk about how fabulous the latest brand is. Perhaps moms have more to say than what was on Oprah that day or what their kids had for breakfast. Perhaps we have an obligation to make a substantive contribution to these important discussions.

And perhaps moms, when shown what kind of resources are out there, can muster the courage to talk about their own private challenges and help show other moms where they can find help to meet their own.

So kudos and thanks to Dr. Myrna Weismann and Julie Totten and Stacey Leibowitz of Families for Depression Awareness. Special thanks to Parent Bloggers Network. And of course, many thanks to the bloggers who participated:

Amy Tucker, Taste Like Crazy
Rita Arens, Surrender Dorothy
Jenn Satterwhite, Mommy Needs Coffee
Christina McMenemy, A Mommy Story
Vivien Bruss, Cool Moms Rule
Dana Tuzske, The Dana Files
Alyson, Three P's in a Pod
Dianne Hoffman, The Mommy Diaries
Kristen Chase, Motherhood Uncensored
Julie Marsh, Mothergoosemouse

I'm trying to get audio of the discussions over to the folks at FFDA, but the audio quality (I HATE SPEAKERPHONES) is giving me fits right now and there were some other distractions during the discussions so it's taking me longer than I hoped, but it will happen sometime soon.

Can Bloggers REALLY Affect Health Policy?

Last week my colleague Bill Pierce attended a Kaiser Family Foundation event: 'The Health Blogosphere: What it Means for Policy Debates and Journalism." Bill is APCO Worldwide's resident health policy blogger at Virtual Vantage Points, and he had an interesting take on the event.

I was particularly struck by three points he made. First, his declaration of the existence of a "mainstream blogger" - an oxymoron if I ever saw one:

The group, while very impressive and interesting, represented the mainstream of bloggers and the blogosphere, all of them worked for an established media outlet or organization. This in and of itself is an amazing statement. Five years ago there was no mainstream blogosphere it was all way outside the box. We’ve come a long way. But I think there should have been some non-mainstream represented. That was clearly missing.

I'd be curious to know who he thinks qualifies as a "non-mainstream" blogger on health policy. I'll have to ask him. Second, the impact the blogosphere has had on the media:

The blogosphere... has not, and I do not believe will, change the very nature of news, analysis, and information sharing, but its impact has been profound and it will continue to change how we get information. First, and perhaps most importantly, it has forced old style print, TV and radio to rethink how they do business and their business model.

This reminds me of the ideas Richard Stacy and others have posited - the advent of personal publishing and individual content generation has had a profound impact on the media business. No surprise there. But I was most struck by this:

Tom Rosenstiel made an important point. While the blogosphere has expanded the debate, provided a different point of view and added a new medium to get information out into the public arena, it hasn’t changed human nature. We still need to sort out the information we have in making decisions, reaching conclusions or coming to an answer. The blogosphere has not changed this point, nor made this easier. It may have made it more difficult by increasing the volume and decreasing our ability to understand the source.

So the blogosphere has now reduced the barriers to entry not only of the media industry, but in policy development itself. I'm not talking about the more-heat-than-light political blogosphere where blogs focus on the foibles of the opposing team but the community of thought leaders who care less about party affiliation than pragmatic solutions. I think this is an outstanding development - as a guy who's worked in health care and in Washington, I can say without reservation that health policy could definitely use an infusion of new ideas from new perspectives.

However, I still sense an inside-the-beltway, knee-jerk reaction about "understanding the source" here that fits well with the "mainstream" blogger idea Bill mentioned. It's akin to the "Missing Dean Acheson" column David Brooks wrote last week, lamenting the downfall of a "permanent bipartisan governing class in Washington." It's the idea that position within corridors of power implies credibility.

I will be discussing this Brooks column at length in a future post.

Welcome Back

'Nuff ced.

What Will Facebook Do in France?

PunditMom sent me this news, via 5 Resolutions - The French Government is preparing to ban "pro-ana" websites and blogs.

The world's first use of the law to tackle eating disorders is broadly aimed at the media and fashion world, but especially at the websites and blogs of the co-called pro-ana movement.

While many are support groups, others promote starvation as a "lifestyle choice", with girls and young women posting their wasting images as "thinspiration" for others.

Social networking sites such as Facebook and MySpace have recently come under pressure in Britain and other countries to ban their pro-ana entries.

Fines of up to €30,000 and a two-year prison sentence will be imposed on offenders who "provoke a person to seek excessive thinness by encouraging prolonged restriction of nourishment" to the point of risking of death or damage to health. The prison term is raised to three years with a €45,000 fine if the person dies.

I acknowledge that a government-imposed ban like this is a big (and perhaps ham-handed) step, but to me at least the issue with social network utilities like MySpace and Facebook is much clearer and easier. I've written about this a gazillion times before. Facebook currently respects the free speech rights of people who tell sick girls to starve themselves and take narcotics more than they respect the free speech rights of women to post pictures of themselves breastfeeding kids.

Facebook's own terms of service agreement prohibits users from posting harmful content. It's obvious these groups are harmful. It's also obvious that breastfeeding pictures are not harmful, but helpful.

I've reached out to Facebook before - politely and openly - to ask them why. The answer was equally polite, but completely lacking in substance and coherence. I've resisted closing my Facebook account for three reasons: First, I use it for work purposes, though only occasionally (I don't use it for anything else); second, I believe in maintaining contact with people who disagree with me; and third, it's so ridiculously hard to completely erase your Facebook account I'd waste an entire day.

Stay tuned, and let me know what you think...

Protesting Facebook... ON Facebook

I've written I don't know how many times about Facebook's clearly wrong decision to keep "pro-anorexia" groups there, despite the growing body of evidence and medical opinion that these sites are harmful. My latest post yielded a comment from "Lauren":

This article inspired me to create a "Ban Pro Ana/Mia Profiles and Groups on Facebook" group. It only has eight members right now, but I'm hoping it will end up making a difference.

I checked it out, and wouldn't you know it, Lauren is now pushing 40 members. Yeah, I joined the group.

I like the idea of using Facebook to protest Facebook. I just think it's more constructive than walking away. Sadly, Facebook still isn't listening to this group (admittedly still small but growing, and more importantly, right on the merits) or many other protest groups, but if enough users speak up I do think they'll ultimately revisit the issue and change their position.

So congrats and thanks to Lauren for leading the issue!

Get Your Wonk On

Speaking of nerdiness, one of the coolest things about the intertubes is it gives wonky nerds like me a place to play without being picked on by the bullies we knew in junior high school.

I learned about Health Wonk Review by doing research for Virtual Vantage Points. (Bill Pierce has another interesting post up there this week about single payer.)

HWR is led by a collection of health policy bloggers who share their wonky best with each other. They run down the health care proposals of presidential candidates, they look at trends in the industry, and basically show the rest of us that they're smarter than we are.

HWR is hosted this week at Bob Laszewski's Health Care Policy and Marketplace Review, and it's really strong this week. Having worked in a hospital and in the Senate, it's pretty much the coolest thing out there. (Yes, nerdy. I know.)

Political or communications experts looking for those "validating third parties" don't need to look much further than here. Just make sure your brain is working before you check it out.

WHAT DO WE WANT? WHEN DO WE WANT IT?

Best wishes to "Lactivista" and "Pregerella" and the crew of moms participating in the Great Virtual Breast Fest today. I may be wrong, but I'm pretty sure this has never been done before - at least not in such an organic, grassroots fashion. It's amazing what a small group of people can do when sufficiently motivated and armed with just a few tools.

And some relevant, helpful advice from my wife this morning, as always, based on the research.

UPDATE: The LMJ's video montage was a top-ten most-discussed video on Youtube yesterday.

My Conversation with Facebook

Rather than insert a bunch of new commentary on Facebook's banning of a breastfeeding pic while allowing 350 pro-anorexia groups at this point, I think I'll just print the emails to and from Facebook verbatim. I will keep the name of the person I corresponded with confidential, and I should stress that the person was prompt, professional, and courteous.

For background, I've written about this here, here, and here. My wife discussed some of the scientific data on "pro-ana" sites and offered some really helpful advice here.

So here goes, the email I sent at 8:02am Wednesday:

Hello -

I'm David Wescott and I'm a member of Facebook. I write a column for Business Lexington called "Living Locally, Working Globally." I also write a blog called " It's Not a Lecture." The Lexington, KY network on Facebook is rather robust, as you may know. You may also know that last month a local Applebee's forced a woman out of their restaurant because she was breastfeeding. This sparked a national protest and it continues to be a topic of discussion on the national level.

I was surprised to read reports in the Canadian media that Facebook had banned a member because she had posted pictures of herself breastfeeding her child. I noticed a newsworthy disconnect when I also learned via BBC and Canadian media sites that Facebook has roughly 350 "pro-ana" groups not only condoning anorexia but suggesting ways for people (young girls suffer from anorexia disproportionately) to continue to starve themselves. Recent research published in the International Journal of Eating Disorders found that visiting "pro-ana" websites made women feel
negative emotions and have poor social self-esteem. I am not aware of any scientific data that suggests looking at pictures of breastfeeding women elicits similar emotions or responses.

I have written about this disconnect on my blog and I'm planning to write a column on the free speech implications - specifically how a social networking site would clamp down on speech and activity on the issue of breastfeeding but not on "pro-anorexia" groups. I want to give you an opportunity to respond - explain your policy, perhaps give some background on the situation that I may be missing. I am aware that there are many pro-breastfeeding groups on Facebook. I am also aware of a new protest group with several thousand members.

I would appreciate a statement or comment from you regarding this specific speech issue and the apparent disconnect here. Please email me at [email address] by Thursday, 5pm ET with any statement or relevant details, or feel free to call me at [cellphone]. Thanks much.

Here's what I got back:

Hi David,

Facebook does allow mothers to upload and share photos of themselves breastfeeding their babies, and those photos remain available on Facebook as long as they follow the site’s Terms of Use. Photos containing a fully exposed breast do violate those Terms and could be removed. Facebook’s Terms of Use can be found here: http://facebook.com/terms.php

Please attribute this statement to Facebook or a Facebook spokesperson.

Thanks,

[name]

So I wrote back:

Thanks [name] - I appreciate the quick response.

Did the specific case reported in the Edmonton media last week involve a case that violated this policy?

And do you have any statement regarding "pro-ana" groups on Facebook?

I also called at this point asking for clarification on the Edmonton case, and I was referred to the earlier email. I think this is because Facebook's privacy policy probably prevents them from discussing issues regarding a specific member, which I totally understand and respect. Within a few minutes I received this:

Hi David,

Facebook supports the free flow of information, and groups provide a forum for discussing important issues. Many Facebook groups relate to controversial topics; this alone is not a reason to disable a group. Facebook considers whether the content on wall posts and discussion boards of groups offer opinions on both sides of the issue. In cases where content is reported and found to violate the site’s Terms of Use, Facebook will remove it.

Please attribute to Facebook or a Facebook spokesperson.

I think I'll just open it up here at this point for discussion, and then I may add some thoughts of my own later. And I do plan on writing a column about this. But I thought it was important and fair to get Facebook's comments out there, verbatim, in public - and I pledge to pass on anything else they send me.

Transparency in healthcare is just plain hard

While basking in the euphoria of knowing Keith Sprankle is following me on twitter...

My wife brought this to my attention in an email on Tuesday:

Next spring, the government plans to release data showing how consumers rate care in hospitals across the country. But Northwest Community Hospital isn't waiting: Its results already are up on the Internet.

I also noticed that Paul Levy saw the same issue and said simply,

Won't it be a pleasure when stories like this one cease to be newsworthy?

Well, of course it will. But this will be newsworthy for quite some time because:

There are no exact numbers on how many hospitals have taken this step and no standards governing the disclosure of quality information. Many data sources exist, and medical centers could leave out information that portrays them in an unfavorable light. Experts recommend that consumers be aware of the potential for bias and discuss findings with their physician.

So, sure, kudos to the hospitals that choose to jump ahead a bit and get their data out. But let's make sure they paint a complete and accurate picture - no simple task. Because transparency doesn't work if you only go half way. And it's impossible for consumers to compare hospitals if we don't have common standards.

Of course, there are already a lot of smart people working on this in the private and public sectors. But we're years away from consensus on reporting methods -- perhaps it does make sense for hospitals to report everything they can and let the market figure out what's most important.

(This is when I'm really happy that Paul Levy has his job and I have mine.)