Hive Health

From this January onward, the Hive writing team produces a monthly review on a key text. First in the series is the 2011 Pulitzer non-fiction winner – a vivid biography of humanity’s  greatest mortal dread.

At the conclusion to his extraordinary history of cancer, Siddhartha Mukherjee, an Indian-born, US-based cancer specialist, posits that ‘as the fraction of those affected by cancer creeps inexorably in some nations from one in four to one in three to one in two, cancer will, indeed, be the new normal – an inevitability. The question will not be if we will encounter this immortal illness, but when.’

That Mukherjee’s book is so compelling isn’t due solely to the drama of the story he tells, but because he is alive to the efficacy of art as well as science. ‘Normal cells are identically normal,’ he writes, ‘malignant cells become unhappily malignant in unique ways.’ His repurposing of Anna Karenina’s opening line is more than a rhetorical flourish: it’s indicative of the intelligent and illustrative way he approaches his material. Like all well-executed ideas, the question it raises is “Why hasn’t anyone done this before?”

The Emperor of All Maladies follows cancer from the palaces of ancient Persia to the R&D campuses of modern pharmaceutical companies. The majority of the story, however, takes place in the mid-to-late 20^th century, when increased life expectancy in the western world saw the prevalence of cancer skyrocket (in third world countries cancer doesn’t even make the top 10 causes of death).

Mukherjee’s story centres on two figures who defined the post-war struggle against cancer. Sidney Farber was a paediatric pathologist who became the father of chemotherapy. Mary Lasker was a wealthy socialite and fearsome lobbyist who believed that if enough money was aimed at it, cancer could be vanquished. In 1971, after nearly 20 years of their campaigning, President Nixon declared the ‘War on Cancer’: legislation that devoted millions of dollars in federal funds to finding a cure.

Farber and Lasker’s achievement was of mixed worth. ‘Cancer,’ Mukherjee writes, ‘a shape-shifting disease of colossal diversity, was recast as a single, monolithic entity’. Scientists competed to find cures, theories of prevention were all but non-existent, and misguided treatments such as megadose chemotherapy did more harm than good.

Mukherjee’s recreation of the ambitions, disappointments and, occasionally, triumphs at each stage of the fight against cancer is one of his book’s greatest achievements. He successfully places the reader in whichever era, lab or ward he describes. He also renders cancer itself in a way that’s both horrifying and gripping. Of leukaemia he writes, ‘Its pace, its acuity, its breathtaking, inexorable arc of growth forces rapid, often drastic decisions; it is terrifying to experience, terrifying to observe, and terrifying to treat.’

The book’s final section is its most optimistic and most complex. Harold Varmus and J. Michael Bishop won the Nobel Prize in 1989 for proving the link between cancer and genes, which led to the subsequent identification of many oncogenes (genes with cancer-causing potential). ‘Having wandered in the darkness for decades,’ writes Mukherjee, ‘scientists had finally reached a clearing in their understanding of cancer. Medicine’s task was to continue that journey toward a new therapeutic attack.’ This came with development of drugs such as Herceptin, which targets an oncogene in a particular type of breast cancer.

But Mukherjee is too knowledgeable about cancer to be swept up in an optimism that has, time and again, proved false. Other gene-targeted therapies like Herceptin and Glivec may emerge over time, but that’s a forecast quite different to the ‘cure for cancer’ that has been dreamed of for so long. ‘This War on Cancer,’ he cautions, ‘may best be “won” by redefining victory.’

Mukherjee says the idea for his book was hatched when a patient asked him the simple question, ‘“What is it, exactly, that I am battling?”’ His answer, all 500 pages of it, is fascinating, depressing and exhilarating, and his writing on lung cancer is so affecting that, after 24 years of smoking, I haven’t had a cigarette since finishing the book six weeks ago.

Have you read this book? We’d love to have your comments.

Monday kicked off my winter night class on Experience Design at Central St. Martins. Asymetric haircuts, country headwear, the diverse and arty greeted me for a 10 stretch of academia. I even took a pencil to sketch  with whilst looking into the mid distance.

Experience design is just that and far from just that. Dozens of man-years have been spent crafting a definition that still struggles with the difference between art and design, let alone the requirement we have to trap, cagoule and force down the edges of what it is to be experiential or to provide experience. The wooliness of the subject is refreshing and helping get my head out of the structured, problem/solution world that billable work often requires (especially on a Monday!).

From 5 senses, to 360 degree immersive sessions it’s clearly going to be an awesome 10 weeks.

My reading list is whizzing past Hegel, Marx, through terms as diverse as relational aesthetics and dystopian community. It’s been a while since I read something (Harvard biz review tends to pride itself on accessibility!) that had me rubbernecking to google this regularly. Blindingly good stuff, even this early session got me thinking like mad on a stack of plans/briefs/trickies I have in front of me.

In a world where ‘Brand is…’ is cumbersome and ‘brand does’ becomes more central to our planning model - experiential planning is pretty sexy for me. It channel planning with lipstick on, spinning on a table, air thick with perfume.

With HBR continuing to kick sand in the face of goods providers with yet another article on the worth of the experience economy. Joining the greying of the boundaries between sponsorship, co-branding, commissioned design, corporate installation etc. And Josephs Pine conforming that customer value has run away from all the  commodities and goods, towards tailored services or authentic experiences. It it  the time to try and consider how we offer these experiences, planned, proactive and of course with an audience insight bang in the centre.

With crossed fingers, in a dark, endless cold room . I am hoping that experience design and the time spent with the talent at CSM contributes a component  to me working on a structured approach to behavioural change achieved along a considered, multichannel, richer journey.

In the meantime – a rather nice Nokia experience, corporate installation, co-branded event, light show or Son et lumière (your choice).

I stumbled upon this gem of a programme whilst curating Patient Centricity news on Scoop it this morning.

Matt and I are heading up to Salford on the train, it’s pitch black, and dead depressing. This cheered me up somewhat and stirred a long gone memory.

I only just remember my sister being ill when I was about 6. A more distinct memory was her accompanying bear; Peri.  Peri pretty much was present all the way to health. Every now and then Peri is discovered still with his hospital wristband on and much smaller than I remember.  I now know that this little bear was named after a Heath Robinson looking yogurt pot, tube and bag gizmo that provided her with the peritoneal dialysis needed whilst her kidneys took a kicking,

This enterprising inspiring mum took her son’s similar requirement for a cancer companion to the next level. Just after his first birthday, Gabe’s mother, Lu Sipos, made the very first Chemo Duck for him. She thought he could use a companion to take to the hospital, one with whom he could share his journey back to health. Both Chemo Duck and Gabe finished treatment in November 2003 and have remained cancer free since.

Since then Lu along with a board of directors and a newly formed not for profit organisation have taken the chemo duck and made him fly. Chemo duck is now in production and the team are striving to give away 10,000 of these donated friends by Gabe’s 10 year birthday.

More than a companion chemo duck has become a vital part of ‘medical play’, a concept that allows children to communicate with parents and healthcare professionals, offering a window into their world midst the turmoil of cancer. Chemo duck is used time and time again as a powerful therapeutic and teaching tool used in medical facilities to familiarize children with cancer protocol and procedures.

Pretty cool eh?

This article was written by Max G, an account executive candidate as part of a first interview to help us see where his MA in International Relations from LSE and our world of healthcare collide. We are delighted to welcome Max to Hive in January.

This is, to quote Tim, a Darwinian moment. The cusp of a revolution and a moment for new thinking and creative minds. The patient is coming, the power structures are diversifying and it’s the job of folks like us to harness that power and use it to effective ends for our clients. Critically, this will mean truly respecting the conflicting and often contradictory wants of patients, instead of merely seeing digital and all things social as just another channel for vulgar old-ad indoctrination. More than anything else, this will mean actually listening to patients: learning from them and understanding their needs beyond the most basal of levels.

Just for the sake of thinking, it’s fun to draw parallels across disciplines. It can also be genuinely productive.

Take the body of literature surrounding U.S. Public Opinion and U.S. Presidents. At the LSE I took a course that addressed the interaction between Presidents and public opinion and I was particularly fascinated by the moment at which the existing consensus completely broke down. Critically, the power-players – i.e. the President – had absolutely no idea how to handle the new climate. It was akin to Reagan’s Secretary of State, George Shultz, visiting Gorbachev in the Kremlin in the late 1980s and telling him ‘The Information Age will destroy your economy if you don’t afford it the room to breathe’. The powers that be were the ones to lose out.

Think of the drugs companies as the President and the patients as the voters. To take the cast a step further, imagine Carter’s team of experts and his Presidential pollster Patrick Caddell – as the tired old ad man who simply clings to the methods of old.

Prior to the end of the Vietnam War and the election of Jimmy Carter in 1977, political scientists and commentators alike agreed that the ‘bully pulpit’ style of Presidential leadership dominated and that the masses had little to say or think, other than that which they’d already been told. In other words, if the President shouted loud enough, the public generally went along. The people were ignorant and malleable. This was termed the Almond-Lippmann consensus.

Similarly, for years the GP-patient relationship consisted of linear, one directional messaging where the GP told the patient what’s good for him and the patient minded his Ps and Qs. Why, as a patient in this climate, would you engage with a brand that meant nothing to you? You were simply told to take it. The brand name sounded scary and the active ingredient scarier. There was no reason to connect with a brand and more importantly, no one had ever muted it as an option. The President knew what was best for you.

Back in the world of politics, The Vietnam War changed the underlying conditions of public opinion dramatically and new scholarship by the likes of Katz and Witkopf asserted that the public was increasingly ‘activated’ on foreign policy issues. The consumer of policy had suddenly woken up. The trouble was, no one had bothered to tell Carter. Or rather, both him and his top-team wouldn’t listen. In critiquing the failures of Carter, one school of thought argues that Carter’s bold and brazen honesty and New World Agenda was simply too much for a typically Conservative American electorate to consume in one go. Honesty, it is argued, was the cause of his failure. For another school, Carter simply didn’t care about public opinion at all.

On the contrary, Carter failed not because he cared nothing for public opinion, but because he failed to appreciate the changes to the underlying landscape and continued to treat the electorate – or for the sake of this analogy his ‘customers’ – as ignorant drones ready to be led. The contradictions in their views meant nothing; little had really changed. From this rapidly expiring rationale, Carter tried to sell something like his human rights policies as ‘non-ideological’ and one-fit-for-all, as opposed to understanding the complex underlying reasons why different voters supported the very same policy, but for markedly different reasons. Far from pleasing everyone, this linear approach to strategy failed everyone.

Back in the world of health care in the 21st century, almost all major stakeholders now appreciate the degree to which the landscape is changing. They get that choice and patient empowerment is coming and that patients are broadly embracing of it. Worryingly however, many traditionalists see this new medium as broadly compatible with the tired old information dissemination of old. Bully pulpit ring a bell?

That’s where Hive and our team of smart cookies come in. We see the irony in giving a presentation on digital in a room full of stuffy insider types through the medium of an overhead projector. Instead, we actually seek to understand patients in their most complex – and thus natural of underlying forms. We tailor our clients’ products to this end and take power back through the empowerment of others. To some observers, this method might seem like pretension defined. Or to others as a serious challenge to the status quo. To us, it’s a holistic approach to the demands of an entirely new and still-emerging world. Digital isn’t just a corporate buzzword and choice means genuinely listening to and respecting the needs of patients.

The way we see it, you can either come with us for the ride or end up like another Jimmy Carter – as much as we love the old peanut farmer.