Thursday, November 16, 2006

FDA expands use of breast cancer drug

FDA expands use of breast cancer drug

Thu Nov 16, 7:22 PM ET

The breast cancer drug Herceptin received expanded federal approval Thursday to include treatment of some women after they have undergone surgery.

In two clinical trials, women given the drug along with chemotherapy had fewer relapses in the three years after surgery — either to remove a lump or the whole breast — than those just given standard chemotherapy, the Food and Drug Administration said in announcing the additional approval. The drug is made by Genentech Inc. of South San Francisco, Calif.

Herceptin is only for the estimated 20 percent of patients whose breast tumors churn out too much of a protein known as HER-2. About 50,000 women in the United States and 250,000 worldwide are diagnosed with this type, called HER-2 positive, each year.

In 1998, the FDA approved Herceptin to treat breast cancer after it had spread to other parts of the body. Thursday's approval expands its use to women with cancer in the breast or lymph nodes that has been surgically removed, the FDA said.

The most serious side effect of Herceptin is heart failure. Only patients with HER-2 positive tumors, and who do not have heart failure or a weak heart, should be given the drug, also known as trastuzumab.


On the Net:

Food and Drug Administration:

Genentech Inc.:

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Monday, November 13, 2006

Web-Based Search Engines Help Diagnose Difficult Cases

Web-Based Search Engines Help Diagnose Difficult Cases

Reuters Health Information 2006. © 2006 Reuters Ltd.
Republication or redistribution of Reuters content, including by framing or similar means, is expressly prohibited without the prior written consent of Reuters. Reuters shall not be liable for any errors or delays in the content, or for any actions taken in reliance thereon. Reuters and the Reuters sphere logo are registered trademarks and trademarks of the Reuters group of companies around the world.

NEW YORK (Reuters Health) Nov 10 - Using Google to conduct web-based searches on the internet can assist in the diagnosis of difficult cases, physicians in Australia report in BMJ Online First. In fact, the investigators believe that Google may be more effective than using PubMed.

"Useful information on even the rarest medical syndromes can now be found and digested within a matter of minutes," write Dr. Hangwi Tang and Jennifer Hwee Kwoon Ng.

According to the two clinicians, based at Princess Alexandra Hospital in Brisbane, physicians and patients are more frequently using the world wide web to find answers for health problems.

After witnessing a patient's father correctly diagnose his son's condition as "Paget-von Schrotter syndrome," the two clinicians analyzed in more detail how well Google is at leading doctors to the correct diagnosis.

They obtained 26 cases published in The New England Journal of Medicine during 2005. Without reading the differential diagnosis and conclusion of each case, they selected three to five search terms from each case. The researchers then did a Google search for each case using those terms, and selected the three diagnoses that seemed to fit the symptoms and signs.

It turns out they were correct 58% of the time.

For some of the other diagnoses, Google gave a correct diagnosis that was not specific enough for the physicians to consider it to be correct. For example, the Google diagnosis was "extrinsic allergic alveolitis," instead of the more specific "extrinsic allergic alveolitis caused by Mycobacterium avium."

The authors point out that their chances of success were increased by selecting "statistically improbable phrases" and scanning no more than five pages of the search result.

Drs. Tang and Ng believe that a web search will be more effective for conditions with unique symptoms and signs. Less success will be achieved with non-specific symptoms or common diseases with rare presentations.

Google has access to more than 3 billion articles, they note, and "has far exceeded PubMed as the search engine of choice for retrieving medical articles." It will be even more valuable when it releases a new version, Google Scholar, because it will include only peer-reviewed articles.

BMJ Online First 2006.

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From the AdTech Blog: Linking and Optimization for Better Rankings and More Traffic

Linking and Optimization for Better Rankings and More Traffic

An intense session on how search engines work. Mike Grehan, "Global Search Marketing Nomad," wrote the first book on SEM and started with a series of bad joke. Bad jokes aside, it was a great dissection of how things work.

The most frequent question Grehan is asked is, "Can you help me get into top 10 of major search engines?" Why should you be? The answer is difficult, but he tried to cover the major points of SEM. He covered a lot of ground in this session. Here's what he talked about (sort of like the notes I took in class).

1. The 4 Ps of Online Marketing
Positioning: Using paid and organic search to drive traffic
Permission: Opening a dialogue with potential new customers. CRM. Get an e-mail address.
Partnership: Affiliate marketing, co-promotion, sponsorship and joint venture.
Performance: Measuring the success of your web site and online marketing strategies.
2. The Search Marketing Mix
Ask yourself the following questions. Who are we? What do we do? What are we known for a? What's your message? Then list the top ten phrases which cover the content of your website. Each phrase (or search term) should be two words or more. Talk to people OUTSIDE the organization! Grehan once had a discussion with a bank client who said "we lend more money than anybody else in America", so "Lend money" should be the keywords. Wrong. The keywords should be "borrow money". Put yourself in the mind of the searcher. Talk to telemarketing people to get a handle on this.
3. Preparing a Campaign
Be sure you have a unique page of good quality content for each search term you want to be found under. Remember: Search engines return web pages - not websites! You need to optimize every page for search
4. How Search Engines Work
There are six ways search engines work:
Pay per click
Cost per click
Pay for consideration (like Yahoo, one of our editors will visit your site within 7 days)
Pay for inclusion (Yahoo, Inktomi)
Trusted feed (XML feed for e-commerce sites)

It's a good idea to use a norobots.txt file to exclude landing pages for campaigns, for example. Search engines will penalize you for duplicate content.

Getting to the top 4 listings is even more imperative. A lot of times with Google where there were 2 paid listings now there are 3, which push organic listings down "below the fold". According to a recent study consumer behavior. People would prefer to reformulate a query rather than scroll down.

Organic results are a bit like doing PR. Pay per click is like buying targeted classified ads.

Where do people look? Upper left side of search results pages dominate--and in fact, more than 70% of clicks take place in organic results.

How do search engines work? Andrew Broder was at Altavista and has formulated a "taxonomy of search":
Navigational: when a surfer really wants to reach a particular website. This goes directly to the website.
Informational: really looking for factual information on the web. Looking for specific info, very close to classical information retrieval. Like the purchase cycle: start with something ambiguous, then refine. User intent is key.
Transactional: the surfer wants to do something on the web, through the web. Shop, download files, find a service like yellow pages.

Grehan recommended that we stop obsessing over crawler activity. Crawlers follow links and collect text, period. They have only the tiniest influence over ranking (an off page factor). It's possible to rank at a search engine without ever having a page crawled.

Most search engines use a "vector space model": term frequency in the document, how many times does it appear on this page? When writing copy for web pages, be as focused as you can. Keyword position and proximity are key. Use:
Keywords in title
Keywords in headline
Keywords in body copy
Keywords in alt tags
Text links and/or link to site map

Remember, you're writing for a "man and a machine." The best analogy is to think that a search engine is like a blind person reading a newspaper: straight to the title, then the headline, then the body copy. Here are some more tips:
Metatags: Fine for controlled homogenous corpus/collection e.g. a digital library. Very poor for heterogeneous corpus/collection with no standard/control
Don't worry about Page Rank - He calls this "GAS - Google Anxiety Syndrome". Pagerank is green fairy dust.

Links. However, are important. Hyperlink analysis algorithms make these eassumptions
1. a hyperlink from a to b is a recommendation of b by a
2. if page a and b are connected by a link, they might be on the same topic
3. if c links to to two pages, a and be are co-cited and related
You need to get links from cyber communities--one great link from inside your community is worth a thousand lesser links. You have total control over who you link to . Reciprocal linking works.

Grehan concluded with his "10 essentials about linkage":
1. Remember, it's quality material which other content sites want to link to. When they link to you, their reputation goes with it. Content is king. Go to your website and write 10 reasons why people should link to your site. If you can only find, 5, you should rethink your website.
2. Search engines look at anchor text in links and text close to the links to give them a clue as to what the existing page is about, and also what the target page is about. "Click here" is the most used and abused anchor text. Don't just say "click here". Say "click here for everything you wanted to know about blue widgets". The target page should have these words as well. Go to Google and search for "click here." The #1 result is the Adobe Acrobat download page, yet click here doesn't appear on this page--everybody's links say "Click here to download Adobe Acrobat." Googling "miserable failure" will take you to George Bush's home page (which has no mention of "miserable failure"). Do it within reason.
3. Search Engines have already decided who they think is important. So use search engines to find linking partners. Use this syntax: But it's better to use a keyword/phrase search. It's a good idea to look at your competitors this way.
4. Don't dilute your quality content by trying to spread it out over the whole site if it's not necessary. Create one good, comprehensive page that others will feel compelled to link to or which you can suggest as the most authoritative page on the subject matter to which to link.
5. A well-run affiliate program can bring you plenty of traffic and deliver plenty of sales. But an affiliate program could also cause havoc with your linking strategy. A redirected link via commission junction or clickbank can deplete the power of any direct links you may have already had
6. Do be choosy about who you link to and who links back to you.
7. Don't try and fake your linkage doata. Don't create spam islands ready to be blown out of the water. SEs can see if links grow too quickly and kill you.
8. How do you ask for a link? Provide a value proposition
9. The links business is very time consuming. Should I get someone else to do it? Maybe even buy a robot to do it. Weigh this carefully.
10. Unless you want to be a business directory don't waste time building a link directory--build your content and your business.

At the end of a whirlwind session, Grehan gave this last piece of advice. Keep track of your backlink data. Keep a spreadsheet of your rankings. If you drop down, check links. One of his clients dropped from a top position to somewhere in the low thousandth position. A link on a news site can break if the site changes content management systems, and broken links plummet in rankings. According to Grehan, all it took was a call to the publisher to fix the link, and after a few days the position was restored.

I guess it works well if you've done your homework as he recommends.

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From the AdTech Blog: Big Pharma Shifts Bucks and Attention to Direct

Big Pharma Shifts Bucks and Attention to Direct

The FDA approved DTC in 1997. The shift in DTC is an unbelievable opportunity for online. DTC will not go away, there will be a shift to more appropriate communication. The doctor-patient dialogue is essential. Facilitating the dialogue is critical. The current model doesn't work. This panel explored what needs to be done.

Moderator: Joe Hartnett, Hartnett & Associates
Meg Columbia Walsh, Managing Partner CommonHealth Consumer. Pharma and consulting background.
Megan Shawcross, EVP at Xchange. 20 years of making customers the focus.
Bonnie Becker, Director of the pharma category at Yahoo Search Marketing. Was at Pfizer for 5 years, worked in global marketing at Polaroid. At Yahoo is focusing on Pharma to develop best practices.

The FDA approved DTC in 1997. By 2004 $2.5B was spent in DTC. There have been pharma shifts in 2005, many caused by the safety issues with Vioxx and Celebrex. Bill Frist said "drug ads fuel America's skyrocketing drug costs" and "drug companies should wait 2 years before DTC". This caused a change in legislation and changed the market-- DTC is much more restrained now.

We go in and out of paying attention to Pharma as a sector. The shift in DTC is an unbelievable opportunity for online. DTC will not go away, there will be a shift to more appropriate communication. The doctor-patient dialogue is essential. Facilitating the dialogue is critical. The current model doesn't work.

CommonHealth did a study of actual doctor-patient visits for the FDA. The result is engagement based on myth vs. reality. It turns out that DTC was not being spoken about the way the pharma companies expected. It shouldn't be "ask your doctor", it should be "present your story". Not closed-ended, but "how does this migraine affect your life?" DTC does work: it drives patients into the doctor's office-- yet patients still don't ask for medications by name. DTC is not hurting the doctor-patient communication. Yet risk-benefit is not being discussed. Surprisingly, only 3% of observed patients actually "asked their doctors" and over 60% of treatment decisions occurred without the doctor providing additional info. DTC has become just another word for mass advertising. We need a new model. We need consumer-targeted communication and more segmentation.

The shift to direct is a shift to relationship marketing. It provides the opportunity to communicate in a targeted fashion to build a long term relationship. Lives change, so to maintain any sense of relevance, you have to be able to evolve the communication in real time. What's true in a patient's life now will change next year. That's where digital has an advantage. Pharma companies are slow and stuck in the paper-based days, but they're catching up. We need to talk about physical plus holistic (emotional, social) needs, to time communication to key moments of truth vs. call cycles or media flights. There's a need to focus on delivering consistent brand perception and experience always.

Consistency is incredibly important in this process. Most people don't make the connection between the drug, name of product, and the manufacturer. We need to deliver in any channel-- the concept of "everywhere" which was so much discussed at Ad:Tech. DTC can't do that now. We can make the connection between brand, corporate, division, etc. It's about being where the consumer is. Pharma companies need to fit the message into the context of their lives, not push information like advertising. Content delivery is becoming richer. Citizen media is growing (podcasts), search engines make everyone a researcher. Pharma companies need to personalize pull marketing, not just push marketing.

Public and political pressure are accelerating DTC changes. Media consumption has changed-- adults 50+ now spend over 7 hours per week online-- more than with magazines and newspapers. Pharma spending is shifting online, with 35% growth last year. Over 60% of the US population 18+ looked for health info online. 34% of searchers would never take a medication without first looking it up online. 61% of searchers plan to see the doctor after searching. 71% of searchers talk about treatments with doctors. Health consumers are hyper-engaged online, not just looking at health but at everything online. You need to target your audience online via increasingly specific channels: Mass and mass-targeted media, behavioral targeting, and context. Marketers are engaging with sight, sound and motion. Interactive ads are positive because they allow the user to engage your content without leaving the page.

Now comes the digital evolution with social media, "we media" like YouTube, Myspace and flickr. You can get answers from your peers who have direct experience. You can have a diabetes community and social search such as on Yahoo Answers where users provide answers to the community. This happens within minutes, not hours or days.

Trust and permission-based maketing is more important than ever. It took 12 years for pharma to go online, they need to move more quickly to community-based dialog. According to the panelists, pharma had "better show up" in the communities. The boomer audience goes in with full treatment agendas when they visit a doctor, then go back online to validate "Is the drug I was prescribed the right one?" There are great partners in Yahoo and Google, and pharma companies need to use them.

It was a fast-paced session with lots of interesting info. There's a lot of room for what the panelists called "total solution holistic communities" which can be sponsored by the pharma industry. The panelists encouraged the audience to explore these opportunities, as they thought there were some nice economic opportunities there.

It will be interesting to see if, as the big pharma companies actually do engage their audiences more, they'll be able to do the hard work of listening, which is key to relationship building. We'll look forward to an update next year...

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The Value Of Integrating Search And Display

The Value Of Integrating Search And Display
by Yoav Arnstein, Monday, Nov 13, 2006 6:00 AM ET
ONE OF THE MANY CHALLENGES marketers are facing today is identifying ways to successfully integrate search and display, given the increasing dominance of these two categories in online advertising. Earlier this year, JupiterResearch forecast that search would lead online ad spend growth over the next five years, increasing from 41% of all online ad spend to 43% by 2011. Meanwhile, the firm predicted rich media would grow at a 21% compound annual growth rate, with video ad spend increasing at a 27% rate through 2011.

In many cases, search and display are still siloed practices, often reducing the effectiveness of both. In order to maximize each ad dollar while generating maximum brand impact, response and correct attribution of acquisitions, advertisers must fully integrate their digital marketing campaigns across both disciplines. As the use of emerging channels like gaming and mobile proliferate, integration will have ever more increasing importance.

Creative agencies and media planners are increasingly demanding integration of search and display, in order to better serve the brands they represent. To achieve this, many agencies are bringing search expertise in-house, investing in necessary staff and technology. As the scale of online campaigns increase, agencies also need more effective display campaign management.

Another agency demand is for technology that helps optimize online ad spend, especially as budgets increase and the online advertising landscape becomes more complex. More than ever, advertisers need to see maximum impact for each dollar spent online.

Without integration, budgetary decisions and allocations are made up front, even before campaigns are conceived, without any knowledge of performance. By integrating search and display, advertisers can make budgetary decisions during and after planning phases, giving the agency partners more insight into the most effective campaigns, as well as the ability to make changes after initial metrics are reported.

Additionally, display ads are technologically more sophisticated than ever. Wizard-based solutions incorporating advanced capabilities such as full-screen video, and interactive features such as games, texting and music can help advertisers create and manage display ads effectively. The best technology solutions automate ad creation, while requiring minimal post-production work. For example, a flash video used for a rich media banner ad format can be used within a browser game without expensive and timely recoding.

Technology can also help optimize search ad spend. For example, tools can enable agencies to more effectively credit the publishers responsible for a sale. Agencies previously have only been able to give "full credit" to one site for a sale, even if the user had visited multiple sites leading up to a purchase. Now, using the right platform, agencies can assign "partial credit" for the sale, helping the advertiser to plan for a more optimized spend in future campaigns. Thus an agency would be able to assign 30% of the credit for a sale to site A, for example, and 70% to site B.

To summarize, while there may be a general consensus that a conversion can only be attributed to one ad, be it search or display, in fact multiple ads may have contributed to the "birth" process of a conversion. If we agree with that premise, fair distribution of the contributions provided by different media buys should be taken into consideration when planning a campaign and for optimizing a current buy.

The right tools can also help simplify keyword generation with automatic generation of related keywords through data mining.

Other challenges related to search include managing the bidding process and duplicating audiences and conversions. If optimized, all three aspects of search marketing have the potential to return tremendous ROI for the agency.

Providing the benefits of integrated campaigns, especially on a global scale, is a value-added service that can help differentiate truly forward-thinking agencies from those left behind still grappling with traditional ad vehicles.

Yoav Arnstein is general manager of North America for Eyeblaster. He will be speaking at the Search Insider Summit, which will be held Nov. 12-15.

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Study: Doctors Diagnose With Google

Study: Doctors Diagnose With Google
Monday, Nov 13, 2006 6:00 AM ET
IT'S NOT JUST PATIENTS WHO look up their symptoms on Google. Doctors increasingly turn to the search engine to diagnose their patients, according to a new study in the British Medical Journal. "Doctors adept at using the internet use Google to help them diagnose difficult cases," stated the report. "Web based search engines such as Google are becoming the latest tools in clinical medicine, and doctors in training need to become proficient in their use."
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