Tech Reps in the Operating Room & Other Hoary Tales

So, I had just about finished all pre-surgical prepping.  I had bathed in antibacterial soap to make sure pathogens would flee from me in disgust.  I had listened to the soothing, melodic voice of a nurse, humming a Jay-Z melody, in her quest to lower my vitals.  Now, flat in my back on a gurney, I sign permission slips that would give the man the right to take away parts of me.  The anesthesiologist said I would no longer be required to count backward from a thousand.  Rather, I would slip off peacefully into some dream space, absent the heavy incest mutterings of Freud.  And just before I was wheeled into this action drama, with my sinuses playing a central character, I was asked to sign a waiver that gave permission for a salesperson/technologist to be present in the operating room.  I responded that this presence would be acceptable as long as there would be no transactions over my warm, still body during the four-hour surgery.  And protests rose in the amphitheater like angels pushing back from the heavens’ heavy cumulonimbus clouds.  I recall a nurse in the operating room saying that they would take care of me because they liked me.  I remember saying that I thought it was because I had insurance, thinking before I sank into that blissful pit of despond, that I shouldn’t joke too much with those who are about to cut.  But old habits die hard.

During the run-up to surgery, I noticed how technology is transforming even the most traditional medical practices, such as one I visit outside of Nyack, NY.  All conversations with the doctor are immediately digitized.  An electronic wand sweeps my forehead and my temperature is attained.   And so on.  Within hours, these digital files sit on my surgeon’s mobile device in NYC.

And this is hardly earth-shattering.  Portable technology, especially when imbedded in wearable devices, already allows much of this basic testing to be performed remotely.  Mobihealthnews reports that Sense4Baby, a fetal monitoring system, uses a wireless monitor that straps to the belly of the pregnant woman and transmits data about fetal and maternal heart rates and monitors contractions.  Data is sent via Bluetooth to a smartphone or tablet and is uploaded to a secure cloud.

Perhaps one of the most useful advances will come from maximizing the use of data and to better glean from social media sites what consumers are actually thinking and saying about pharmacology and treatment regimens.  Treato, an Israeli company, has developed and algorithm that scours thousands of social media sites.  Such insights will likely provide the next generation of patient intelligence.

Now back to the salesperson in the operating room.   Before my surgery, I had read at Venturebeat.com about Nurep, a startup that provides medical device support for physicians in the operating room.  From what I understand, this company enables medical device representatives to see more physicians, to increase sales, and cover a broader geography.  The service guarantees physicians 24/7 support in the operating room, including on-demand, virtual support.

For hospitals this is a very touchy issue and most have gone to considerable lengths to restrict access of device reps to physicians, the purchasing department, and the C-level suits.  Some places actually electronically track the presence of reps on the hospital floors.  This is vital oversight as where there is technology, there is big money.  In an earlier blog, I referred to Steven Brill’s masterful piece in Time Magazine about how new medical technologies are driving up patient costs and padding the wallets of executives.

On the other hand, we patients want our doctors to be technologically proficient.  A few years ago, I was undergoing another sinus surgery that involved imaging technology.  This is a useful extension of the surgeon’s eyes and hands when she is poking around the brain floor.  In this instance, the imagining technology failed and the surgeon continued “manually.”   I was not consulted.  And I was not happy about this hand-job.

I live close to Manhattan and am blessed with access to some of the best medical institutions in the world, including Roosevelt Hospital where I spent a little time.  Nonetheless, the adoption of technology is often tied to age, experience, and probably face time with Xbox.   I want my surgeon to be totally at ease with latest technology.  If she is comfortable with a tech rep at her side, so am I.

Just tell me long before I slip into that chemical bliss.

Thanks, Doc!

In Praise of: TIME, The Week, Wired, and Flipboard2.0

The American Society of Magazine Editors (ASME) just announced finalists for the Magazine of the Year (General Excellence) and other awards.  The list includes the familiar and impressive heavyweights: Esquire, Glamour, National Geographic, New York, and TIME.  I don’t envy my friends at ASME the task of sorting through the best of the print best while giving a nod to digital.  So far, all is right with the world.

I was very happy to see TIME on the list, not only because many friends still work there, but also because of the way it was knocked around during the rumors about Meredith acquiring Time Inc.  TIME was said to be left out of that fantasy transaction and a place at the table.  Perhaps this indignity prompted the Atlantic Online post by Joshua Macht, who leaves nothing to the imagination in his title: “Running out of TIME: The Slow, Sad Demise of an American Magazine.”

Thank you ASME for giving this relic of a magazine one last acknowledgement at the upcoming awards dinner because, well, you never know.   But Macht seems to know, suggesting that it’s hard to imagine there will be much left of the brand in 36 months. 

He exaggerates and I exaggerate.  There is some sadness in his blogger voice.  He wonders out loud how Time Inc., so early in the game with a $100 million investment in the Pathfinder portal, long before Google and when Netscape and AOL were still tiny, has not been able to capitalize on the web? Obviously the huge distraction with the AOL deal that some have called the worst media merger in history didn’t help.

But this is all a prelude to the real dance.  Frank Rich’s current New York piece, “Inky Tears” sucks all the sentimentality out of our much-aired historical narrative about the demise of the media titans.  “TIME is on the block.  The New York Times is teetering.  It can get an alumnus down, but the last thing the news business needs is a case of nostalgia.”  He writes that whether print survives or not is borderline irrelevant:  “Survival, not survival of a print edition, is what’s at stake now.”

My earlier remarks about TIME magazine point back twenty years to those halcyon days.  Rich suggests that “If you look back at TIME in its heyday, it’s a model more worthy of parody than emulation.”  Here  Rich is referring to the magazine’s far flung bureaus, editorial redundancy in the extreme, and a profligate waste of money worthy of an Evelyn Waugh satire.  Accordingly, the seeds of the magazine’s decline were planted a long time ago.  The writer notes that “In the modern history of media, the reigning giants have nearly always been caught napping by transformative change.”  There is something almost biblical in that statement.

In the last couple of days, I’ve had occasion to look at The Week, a modest, hardly handsome, print summary of domestic and international news within the fair-use doctrine.  When Felix Dennis of Maxim fame launched The Week in the US in 2001, the WSJ wondered out loud whether the man was nuts.  I know Dennis and have called him a lot of names, but “nuts” wasn’t one of them.  Dennis, who is rich, unpredictable, and a Brit with a wicked wit, gave his best quote to the NYT:  “In the end, The Week will inherit the earth.” 

The Week has neither inherited the wind nor the earth, but it has gained a tidy, secure, foothold on a piece of expensive real estate by behaving like a very traditional print magazine.  It has a paid circulation of about 540,000, a fraction of the 3+ million TIME enjoys.  Its circulation base is almost completely subscription.  Newsstand sales are insignificant as are digital replicas.  The Week sells a lot of gift subscriptions.  The magazine has a very active web site, but is just now looking more seriously at digital revenue-generating opportunities, such as e-commerce and the like, an effort that is likely to be helped by sister company Mental Floss.  The Week is said to generate about $50 million in total revenue with a 10-15% ROR. 

By publishing standard, this is a very small enterprise, but the example is instructive nonetheless.  Over the years, The Week has reminded the publishing community that it is not a legacy magazine trying to adapt to the current news environment.  The magazine identified its niche, filled it, and served the readers well.  My guess is that the ratio of consumers who subscribe to those who renew their subscriptions for the next term is very high.  And this is the secret sauce.  You can bet that Felix Dennis, a stickler on cost control and, as I’ve noted in earlier blogs, a trenchant critic of American magazine cost structures and largesse, has kept the business very lean.  I’ve heard people argue that The Week isn’t a real magazine; that it is built on the backs of other journalists.   This sounds like legacy thinking.

In his New York article, Rich raises the question, first raised by PaidContent, that “At what point does it become more of a hindrance than a benefit to be associated with a traditional media brand?”  Rich is referring here to newspapers and news magazines, but his question probably has broader media implications.  The brand remains the glue, the identity, the existential positioning for media properties.  Magazine publishers now design for branded, edited content that will thrive in a cross platform and cross-channel world.  Print is just one component of this content universe.  This positioning is vital, pragmatic, and defensible in the business sense.  And this approach should become more secure as publishers get better at delivering and monetizing content across these platforms, especially tablets where advertising CPMs are favorable, without all those workflow and staff redundancies.

Speaking of awards:  this is the 20^th anniversary of the launch of Wired Magazine by Jane Metcalfe and Louis Rossetto, a date worth celebrating.  I recall meeting Ms. Metcalfe in 1996, showing up in their office in the low-rent district of SF in my very NY suit and tie to chat about expanding the title internationally.  Three years earlier, New York publishers had rejected their business plan, so they turned to Nicholas Negroponte, founder of the MIT Media Lab, for financial support to publish their version of Rolling Stone for the digital age.  (Ad Week’s Ted Greenwald has a wonderful article on the launch of Wired in the current issue.  The 20^th anniversary edition of Wired will be available for download April 16 and on newsstands April 23).

The launch of Wired now seems gutsy and charming in a way, brought to life by founders who had a clear sense of purpose and who perhaps fortuitously lived three thousand miles from the epicenter of publishing.  The founders could bring in alumni from Ziff-Davis and Macworld to help bring the magazine to life where, in the East, few seemed to speak that language.  I don’t think the magazine would have stood a chance in New York in 1993.

Media disruption today can be found in the app stores.  The joke in Silicon Valley is that everyone is working on an app, but it’s not that funny.  Google just booted 60,000 apps from its Google Play, many apparently spam-like.  I’m working on a couple of mobile apps and have learned how difficult it is to differentiate and bring something genuinely new to market.   And like most in the space, we keep an eye on Flipboard.

The platform is said to have 50 passive and 4 million active users.  That’s a sizeable community any way you slice it.  Though there has been some pushing and pulling with publishers, especially over revenue-sharing, Flipboard appears a useful tool in the publishing arsenal.  And with the introduction of Flipboard 2.0, this relationship could get even more interesting--and complex.

We’re heard ad nauseum for the last decade or so that one grand end-game for digital is to allow every consumer to be an editor and publisher.  To a degree, this wish-fantasy has already come to life as the proliferation of blogging and self-publishing tools have become widely available.  Flipboard 2.0 raises the stakes even more.  In this version, the navigation is much simpler and I can flip through digital pages as if I am thumbing through a print version.  But for me, the really interesting part is that consumers are now able to create custom magazines in literally seconds for sharing or private use.  Have a look at the Flipboard video available on the site and watch magazines such as Living in Trees, Mountain Biking, and Mid-Century Amazing, about houses and the like, come to life.  And with the new bookmarking feature, you don’t have to be on the platform to add content from other sources, such as the web.

Paul Armstrong at PaidContent has referred to Flipboard as a “giant iceberg lurking in the path of media,”  As an ex-Navy guy with long stints at sea, I can appreciate this metaphor, even if it appears to be somewhat overstated.  But Armstrong is absolutely right about Flipboard 2.0 signaling a “pivot from purely curation-based interaction to one that uses full-blown creation abilities.”  

Flipboard’s business model would become much more interesting if the platform became a digital magazine incubator, a media laboratory, an experiment in beautiful branded content, particularly for the publishing verticals, all with the energy and insights of the crowd.  Flipboard could be a real partner to magazines and media companies.

In my most recent post, I wrote that the software that will make content more intelligent and an increasing dependence on algorithms to solve editorial tasks over time will impact the magazine publishing model.  Flipboard might be a more old-fashioned disruptor, making use of technology plus the wisdom of the crowd.  IDG, publisher of Macworld and other computer titles, realized years ago that its readers knew as much, if not more, than its editorial staff and embraced that talent. This seemed an important awakening.

Going forward, magazines publishers will likely need a lot more of this brand of humility.

Intelligent Content, Algorithm as Editor, and Poetry in Decline

After college, I was intent on becoming a full-time poet.  In that pursuit, I read for small cash poems at the American Legion, the VFW, Future Farmers of America, and Daughters of the American Revolution.  I usually selected anti-war poetry and for that reason I rarely got a return curtain.  I had a brief run of success with religious poetry during Holy Week until an Episcopal Church in Bethlehem, PA, objected to my “On the Medical Aspects of the Crucifixion,” which I considered balanced and in good taste.  Soon after I joined Rodale, I read a poem about male executives cheating on their wives while on business trips.  After a time, I found it easier selling advertising.

Poetry is like a skin rash that returns when the seasons change.  After months of chewing on big data and tracking delicious publishing workflows , I decided to take a course, from a psychological perspective, on Czech/German poet Rainier Maria Rilke, author of Duino Elegies and Sonnets to Orpheus, works that still have something to say about soul one hundred years after publication.

I read a few years ago that Steve Jobs was an inveterate reader of William Blake, the visionary 18^th century English poet.  Many of Blake’s contemporaries considered him mad and that’s probably why he is still interesting and T.S. Eliot and Ezra Pound barely survive as academic footnotes.  Blake spoke of “Jesus the Imagination” and the importance of seeing the world through a Third Eye.  Maybe this is where the iPhone was hatched.

Colleagues I haven’t spoken to in decades sent me without apparent glee a recent WSJ piece by Joseph Epstein announcing yet again the end of poetry.  I can barely read my own tea leaves, though I suspect Epstein is right that academics had a lot to do with this decline.  T.S. Eliot trumpeted an aesthetic he referred to as the “objective correlative,” suggesting that every image in a poem has a recognizable referent in the physical world.  And the soul went out the window.  A school delightfully called New Criticism, centered in Sewanee, TN,, grew up in the 1920s around this notion and generations of tight, tidy, analyzable academic-friendly poems were written by poets, for poets and the New York Times Book Review.  I rode the train for many years before getting off at a station called Rilke.

It’s not particularly surprising that university English departments would adopt analytic tools consistent with the time as a way to show prospective students that this discipline had as much science as the psychology and sociology departments.  To aid in this effort, lots of academic journals sprang up in the post-WWII years and fed this hunger and provided university administrators with leverage.  You would either publish or perished.  I published a lot—and left.

I studied linguistic and generative grammar in college and understood early on that “language” was “chunky” and in a way self-generating.  I taught this in a Hollidaysburg, PA, English class and was reprimanded by my supervising teacher for coloring outside the lines.  But this is a long way from machine language reading me and updating content based on my quirks and browsing habits.  This is the premise of Roger Wood and Evelyn Robbrecht, of the Art+Data Institute, in a recent fascinating piece about Intelligent Content at PaidContent.   They write that “books and magazines of the future will act as sort of human computers translating your reading desires into pure machine language that tells the publisher how to present the material for faster and more pleasurable absorption.”

The authors observe that we are seeing the beginning of this development with Flipboard, where consumers can now create, curate and share their personalized magazines with perhaps a revenue-share component down-the-road.  They point out that Wordpress and Tumblr appear to be the closest thing to offering an always-on and continually updated reader experience through analytics.  This brave, not-so-new world “will be filled with mashups, video, audio, real-time updates, new navigation interfaces and even content that interacts with the reader’s environment,” such as Augmented Reality.

Freud declared one hundred years ago that we had to depend on a strong Superego—our civilization and culture--to hold back the dark forces of the unconscious.  Freud was buttoned-up, but did have a bit of the novelist in him and liked to draw large and startling figures.  With much less at stake, I have been listening for at least fifteen years to publishers, including yours truly, who trumpeted with a certain logic that the editor was the last defense against the wild forces of the web and social media that spits out unruly content from a stream-of-consciousness spigot invented by an increasingly mad James Joyce.

Hyperbole aside, this is a defensible position and a vital business posture where “branded content” is a powerful and necessary selling proposition, especially for magazines.  But what if our authors, our seers, are right in their view that the algorithm will replace the editor and curator: “Quick and automatic branding and positioning of the book or magazine on a glowing electric slab will become more important than the most  sage human editor.”

Content farms such as Demand Media, lambasted by publishers and downgraded by Google, might be only the first iteration of using data to develop article ideas.  Wood and Robbrecht go further and suggest big data from reading and search behavior will help predict what articles will likely rate high in terms of reader engagement.  Publishers also will be able to choose subject matter with an eye to ROI.  If true, this would be profoundly disruptive and interesting: software as the secret sauce.  And as the authors indicate, we have only to look at Quartz, Gravity, Contextly, and Sailthru to find evidence of companies that are developing tools to customize, personalize and update content on a device level.

A few years ago, I invited Demand Media into MPA to speak to editors and publishers about their use of search data to decide and shape articles for their various web sites.  The NY editors at this forum were understandably neither happy nor impressed with what they saw.  Demand Media was and is still, to some degree, a race to the bottom from any editorial perspective.  But that was yesterday.  What we are seeing today are analytics that can shape content to a user’s need and subtle inclinations.  This is neither far-fetched nor bottom-fishing.  On the contrary, it is consistent with everything publishers say about the importance of user engagement in terms of the lifetime value of the customer and the immediate P/L.  Intelligent Content can have a positive impact on the bottom line.

These days, we hear a lot about Responsive Design that enables web content to be distributed via templates to the various devices.  This is an important development, but has raised key business and advertising issues that need to be resolved.

It will likely be some time before we see the Algorithm atop the editorial masthead and Intelligent Content the rage.  But the authors present ideas for a content future that already exists in germ.  Writers and editors are becoming more sensitive to content use by marking up content with metadata at birth so it—and they-- will have more value downstream.  They will also have to become more sensitive to analytics and the role of algorithms in reading, serving, shaping and updating content based on what consumers want in real time.  This is why we call it rich media, the new augmented editorial reality.