Imagine you've got some important news—like, life or death information. Say, there's been a zombie apocalypse or a nuclear attack, and you're the only one who knows the location of meds or food that could save the world from pain or famine.
How would you go about spreading the message? Who would you tell first? You need to find your best connected contact, someone influential, to spread word.
Activate Networks, Inc. tries to do this for the healthcare industry: data mining doctors' and patients' contacts, to find the key nodes of medical social networks. They sell the network maps they make—charting the most powerful doctors in the U.S.—to hospitals and (you guessed it) to drug companies—the wealthiest clients with incentives to access the most influential doctors to pitch them pills. By monitoring ties between people through patient records, doctors' referrals, census data, and even corporate email traffic patterns, Activate Networks determines people's relative "impact" or influence on their professional social network.
See last month's New York Times for a sample diagram of this "influence space."
Meta-data on physicians' professional networks is a potent tool for disseminating medical progress, but may also promote dubious drug products to influential but greedy docs, depending on who is using the tool. Medical ethics watchdogs could use these tools to know which powerful docs to keep an eye on.
Activate Networks' business can seem like the online espionage done by the U.S. government and exposed this month by Edward Snowden. Except that, as C.E.O. Dr. Larry Miller is quick to point out, "All of this data is publicly available." Activate Networks' meta data is volunteered by client companies, not taken secretly like the N.S.A.'s. And in the case of email traffic social maps, as with the N.S.A.'s snooping, researchers look only at who is mailing whom, when, and from where, not at the content of the messages.
Still, they can tell from this data a lot about an organization's social dynamics, particularly the key characters of the network, the most interconnected individuals.
These organically formed social webs, Miller says, rarely reflect the structure of the corporate hierarchy: People form friendships and alliances across boundaries of rank and pay-grade, and the most powerful or highly paid member of the company is not often the most influential in terms of contacts. Knowing a company's organic social patterns can help management decide how to disseminate information best.
The company’s social network analysis tools identify key doctors by the breadth and depth of their professional ties. The link between two docs is the number of patient referrals they share: If I’m a family doctor and you’re an orthopedic surgeon, and I have 20 patients who always go to you for their broken bones, then we’ve got a connection strength of twenty; If you’re also the go-to surgeon for twenty other family docs, you’re an influential member of our network.
The docs with the strongest social networks, called chief influencers—the ones tied to the most other docs, through patients—can then be targeted for "behavior change" and best-practice education, helping good doctoring spread from the hospitals where the most effective approaches are pioneered. When used by hospitals, the social map helps cut costs, as patterns of patient flow are recognized and streamlined.
Sounds all good, right? Definitely, when the tools are in the right hands.
The intentions of Miller and cofounder Nicholas Christakis, M.D., PhD, M.P.H. (all Harvard degrees, for both men) seem honest: They're both ex-practicing doctors, whose goal is to leverage data science to cut costs to patients and hospitals and improve quality of care by speeding the spread of good medical practices.
Activate Networks' new techniques for quantifying doctors' influence and visualizing a hospital's network of docs and patients, so that patterns of patient flow, physician collaboration, and hospital resources can be seen and optimized, stand a good chance of revolutionizing healthcare. The only trick is that it's not only the good guys who want access to the most powerful doctors on earth: big pharma does, too.
You may find this sentiment paranoid, but the pernicious influence of pharmaceutical industry money on unscrupulous doctors is a menace to public health, seen from the top of medical academia.
The alma mater of Drs. Miller and Christakis, Harvard Medical School, itself has a notorious history of influential psychiatrists paid by drug companies disseminating dangerous practices. The psychiatrist Joseph Biederman—in 2007, ranked the second-highest producer of high-impact psychiatry papers—popularized attention deficit meds, as well as antipsychotic drugs as a treatment for pediatric bipolar disorder. Kids' bipolar is a controversial diagnosis, since many psychiatrists believe the disorder's symptoms aren't detectable before adolescence—and yet the number of kids treated for bipolar increased 40-fold from 1994 to 2003, no doubt due in part to Biederman's influence. Rules by the National Institutes of Health (NIH) limit a doctor to taking no more than $20,000 from a drug company whose drug he is funded by the NIH to research. Yet the New York Times revealed in 2008 that Biederman had taken $1.6 million in consulting fees from drug companies over 8 years, while researching and promoting their drugs, without disclosing to the NIH or to Harvard. In 2011, Harvard and Massachusetts General Hospital denounced three psychiatrists, including Biederman, for taking secret pharma pay for drugs they researched and promoted.
So the danger of targeted drug marketing to doctors who are both influential, and potentially corruptible, is serious. Psych drugs are especially good targets, because they sell so well and have limitless demand.
Psychopharmaceuticals—the second-highest grossing drug class after blood-pressure meds—are also by far the most controversial, poorly validated and least reliable in terms of efficacy. Two of the six top-selling pharmaceuticals of 2012, Abilify and Seroquel, are meds for the mind (both are atypical antipsychotics, prescribed for depression, bipolar and schizophrenia). Amphetamines prescribed for attention deficit disorder, but commonly taken recreationally, are also blockbuster products for drug makers.
So big pharma has a major incentive to get access to the country's most influential doctors, and persuade them to prescribe more drugs to their patients. Not just for measurable ailments like hypertension and diabetes, but for those intractable mood-problems: sadness, nervousness, sleeplessness, hyperactivity. Since these psychiatric disorders—whose clinical basis, the Diagnostic and Statistical Manual of Mental Disorders 5 (DSM-5), has been challenged by the National Institutes of Mental Health as lacking in scientific validity—have no fixed diagnostic criterion, the potential "market" of consumers (that is, patients) is infinite. Gold-mine for the drug industry, if they can get the right docs in their pocket.
Antipsychotic meds are a $16 billion industry in the U.S. And the side effects of the drugs—not to mention their dubious reliability and efficacy—have been persuasively questioned by psychiatrists from Dan Carlat (Unhinged: The Problems With Psychiatry) to Irving Kintsch (The Emperor's New Drugs) and by medical journalists Robert Whitaker (Anatomy of an Epidemic; Mad in America) and Gary Greenberg (Manufacturing Depression; The Book of Woe). Yet big pharma is promoting them like candy to children—and some well-paid doctors are helping.
Not that any of this is the fault of Drs. Miller and Christakis at Activate Networks, Inc. Their analytics tools seem likely to do good for medicine—promoting good health practices, from exercise to nutrition, not only in hospitals but also in corporate structures and communities. Outside of hospitals', doctors', and corporate networks, the company has applied its methods to the population of a whole city (Manhattan Beach, California), for a public health initiative by Healthways, a Tennessee-based "well-being company," using census data and publicly available address and co-ownership data to determine links between citizens, and to identify the community's most influential members to target for outreach.
But the market forces of big pharma will lead inevitably to heavier pressures on doctors to sell out—to over-prescribe meds whose effects are supported mostly by industry-funded studies. And, because data-mining is a value neutral tool, and Activate Networks is happy to get business from whatever customers want to pay (and big pharma is a deep-pocketed client)—the most influential doctors should be prepared to be bombarded with the full force of medical marketing.
Dr. Miller wouldn't say what proportion of Activate Networks' profits come from pharma companies, but one imagines it's considerable. After all, drug makers have by far the most to gain, in terms of raw cash, from access to "key influencers" in the healthcare network. But then again, the business model Drs. Miller and Christakis have adopted is ingenious: harness pharma money to fund consciousness-raising medical campaigns in hospitals, corporations, and communities, improve healthcare nationally, even globally.
Active Networks isn't alone in living off drug money. It's no secret that pharmaceutical funding is all over the majority of healthcare research, from hospitals to universities. And of course, the goal behind all this research—and all those dollars, and those corporations—is to help sick people get better. Company-produced drugs, from vaccines to insulin to meds for HIV, cancer, blood pressure, and even pioneering treatments for Alzheimer's disease, would never have been found without the deep pockets of industry. No doubt many drug company execs are just as good-intentioned as most doctors: their primary goal is to heal the sick; money is only secondary.
But anytime profit is involved—tied not to public health, but to sales of drug products; profits on the order of $300 billion a year—we've got to be skeptical.
Medical watchdogs, whoever you are, if you're reading this now: Pay attention.
[Doctor Eye Patch: Bikeriderlondon via Shutterstock]