

To Gather Drug Information, a Health Startup Turns to Consumers - mmohebbi
http://www.nytimes.com/2014/09/24/technology/to-gather-drug-information-a-health-start-up-turns-to-consumers.html

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FLUX-YOU
How do you think doctors are going to react to their patients following the
data from Iodine? There's a lot of room to misinterpret, especially when
dealing with psychiatric drugs. Advil, Immodium, and Nyquil are pretty simple
for people to report on: the thing that hurts stops == this drug worked
(maybe).

Also, the one thing on the front page that made the largest impact on me is
the brand name prevalence. If Iodine gets popular, that's going to have a
direct effect on brand name sales. Would you be interested in doing more
upfront comparisons between generic and brand names?

People will still buy brand name if it makes them feel better/safer/whatever
of course, but a 200mg tablet of ibuprofen should have the same effects no
matter who makes it (allergies/reactions from dyes and coatings not-
withstanding). Shouldn't we be trying to educate patients about the science of
it as well? That the same dosage of Advil vs. Generic is equivalent and teach
people to save money?

>The investor enthusiasm for health ventures, said Halle Tecco, managing
director of Rock Health, is fueled by the belief that the health care industry
is both huge and technologically backward, and thus ripe for an assault with
clever software and data-driven decision-making.

From my own experience, this could not be more correct.

I've been on three sides of the healthcare industry: nursing, surgical
services, and now software. There is just a lot of old stuff piled on top of
even older stuff. Some of that is reliable and necessary. Other times, it's a
wonder the thing even works in the first place.

It's a wasteland of opportunity, so grab your hazard suit and start coding
because me, my doctor and my optometrist personally think healthcare software
currently sucks. :)

~~~
mmohebbi
The early feedback we've been getting from doctors and pharmacists has been
very positive. We believe (and many of them agree) that a users subjective
experience of a medication is an important part of the overall equation,
especially with non-compliance being as high as it is.

With respect to brand vs generic, keep an eye on our blog for a post on this
soon but here is a preview:

[https://twitter.com/zimmeee/status/514807668163088384](https://twitter.com/zimmeee/status/514807668163088384)

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YHMCincy
First, congrats on the launch! Secondly, have you considered giving the
consumer the ability to compare (side by side) drugs that are used for the
same condition? For example, anxiety meds. Being able to compare side effects
on the same screen instead of having to start a new search or click and try to
remember what you just saw.

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dekhn
How do you handle the large bias in internet-based surveying (Internet users
aren't demographically representative)? What about the general problem of
recall-based reporting (people may report taking meds when they didn't)?

~~~
mmohebbi
Great questions! For background, I was part of the Flu Trends and Consumer
Surveys teams before I left Google to start Iodine.

Google Consumer Surveys attempts to create a representative sample of the
internet population according to the breakdown from the Current Population
Survey (CPS) published by the Census. This is done at survey delivery time.
Additionally, after the survey is performed, the stats are reweighted by this
distribution since the targeting system isn't always able to deliver a fully
representative sample due to other constraints (publisher volume, survey
volume, etc).

Of course, this only helps with ensuring that the stats represent Internet
users. However, there are many reasons to believe that this sample is a
reasonable proxy for many types of questions. For examples, see:

[http://www.google.com/insights/consumersurveys/static/consum...](http://www.google.com/insights/consumersurveys/static/consumer_surveys_whitepaper.pdf)

[http://www.people-press.org/files/legacy-
pdf/11-7-12%20Googl...](http://www.people-press.org/files/legacy-
pdf/11-7-12%20Google%20Methodology%20paper.pdf)

[http://fivethirtyeight.blogs.nytimes.com/2012/11/10/which-
po...](http://fivethirtyeight.blogs.nytimes.com/2012/11/10/which-polls-fared-
best-and-worst-in-the-2012-presidential-race/)

Additionally, there can be a bias in many traditional survey platforms (RDD
telephone surveys being the current gold standard) due to the adoption of
mobile phones among other things.

With respect to recall-reporting problem, for a subset of users, we asked not
only about the medication but what they were taking the medication for. We do
this in the form of an open ended question and it helps increase our
confidence in what the user reports. Details of our exact methodology are
forthcoming!

------
mmohebbi
We launched today at [http://www.iodine.com](http://www.iodine.com)

The team is monitoring this thread. Happy to answer questions!

~~~
tomwalker
Congratulations on the launch.

I am not sure if some of the drug types are appropriate though.

Antibiotics for example. If someone was prescribed an antibiotic for an
infection, read your site and decided to stop taking it after a few days to
avoid a side effect while waiting for an appointment with their doctor to find
a suitable replacement, then it may increase resistance. Worse, they might
stop the treatment and not bother finding any alternative if they feel "better
enough".

I agree that discussions on medications are good for the majority of cases but
antibiotics should be considered firmly in the domain of the specialists who
"should" take into account local resistance rates, etc.

~~~
amandalotti
Hi Tom this is a great q. I'm the MD on the team here at Iodine.

As you know, many people already stop taking their antibiotics without
finishing the full course. According to our internal research, people get most
freaked out about side effects when they didn't expect them or didn't know
they might happen, and when they didn't know it was a common or normal
response to a medication. It's our hypothesis that surfacing this data (much
of which does already exist online) will actually help with what clinicians
refer to as "anticipatory guidance" \-- helping people know what to expect --
and that this could reassure people when they do have a side effect, and help
them realize that it's temporary. Good anticipatory guidance doesn't always
happen in the exam room due to time constraints, etc. In a couple studies we
cited in an Iodine blog post recently, docs spend an average of 12 seconds
talking with patients about side effects of a new med, and 50% of these new
med convos don't mention expected side effects at all.
[http://www.iodine.com/blog/11-questions-to-ask-about-
medicat...](http://www.iodine.com/blog/11-questions-to-ask-about-
medications/).

Additionally, our content will develop with more info about how to take a med,
including this really important caveat about antibiotics. Another one I can
think of is acetaminophen and its really important risk/warning about liver
failure.

We still have a lot of work to do at Iodine, but we think we've got a good
start. And overall, we think that more transparency is better, even when it
comes to antibiotics, to help people have more informed conversations with
their doctors about this stuff.

