What is SERMO… and can we trust it?

Big things were expected of the new social network for doctors. The reality has proved to be quite different

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When a new social network for doctors hit our shores last year, big things were expected. The reality has proved to be quite different

Case

In May 2015, a 14-year-old boy in the US presented to his doctor with a persistent cough. Standard tests revealed no abnormality, but when the boy returned for follow-up, he brought with him a “branch-like” mass he’d coughed up. The doctor, having never seen such a thing, took a picture of it and posted it to medical crowdsourcing platform SERMO, asking doctors on the network for assistance.

Within 30 minutes, one doctor had responded to the post, and a few hours later a cardiologist identified the mass as a bronchial cast, or plastic bronchitis following a Fontan operation, usually performed for hypoplastic left heart. A respiratory paediatrician confirmed this diagnosis, and the boy was referred to a cardiologist for urgent treatment, which was successful.

The rapid diagnosis may have saved his life.

This is one of several stories SERMO has highlighted as a mark of the success of the platform. But what exactly is SERMO?

How it works

Set up in 2005 by US physician Daniel Palestrant, SERMO (Latin for discussion) started life as an adverse effect reporting system after perceived failures in the system at the time before Merck’s 2004 Vioxx (Rofecoxib) recall. The idea was that registered doctors could post concerns about side effects from medication, learn from each other, and discuss cases with doctors from across the country.

Touted as “the first global physician-exclusive social network”, the free-to-use platform for licensed doctors boasts that over 550,000 doctors in 96 specialities used the platform to post 33,000 items, 626,000 comments and consult on 6000 patient cases across 24 countries last year.

The vast majority of members (around 300,000) come from the United States, but 13,000 have already signed up in Australia, less than a year after it launched here, according to claims by SERMO.

As well as facilitating informal advice and information sharing, the platform is also commonly used as a platform for doctors to vent their frustrations and share entertaining stories, such as weird and wonderful encounters with patients.

The closed Facebook group GPs Down Under (GPDU) or the doctors-only online forum e-healthspace, play a somewhat similar role in this country. However, SERMO allows users to post anonymously – an option that 90% of users take up, according to SERMO CEO Peter Kirk.

“SERMO provides doctors with support from their peers – friends to laugh with, shoulders to cry on and colleagues to vent to and ask for help… [it’s] a place for everyday physicians to share their true feelings about their profession and lives and talk real world medicine,” says Kirk.

“We allow doctors to create usernames and be anonymous on the network so that they feel safe to provide their real opinions without fear of repercussions.”

Indeed, according to a 2014 study commissioned by the University of Sydney, around 66% of doctors reported they were hesitant to participate more fully in social media and online communication due to legal and public access concerns, although this doesn’t necessarily apply to closed groups.

SERMO says that the anonymity option, “addresses these privacy and security concerns”, while a “triple-verification process” ensures that anonymous users are registered doctors.

Controvery

But what really makes this platform so interesting is that as well as being a free doctors-only forum, it is also billed as the “largest health care professional polling company providing insights to pharmaceutical companies and others who want to gather real world opinions from everyday doctors”. According to the platform, 15 of the top 20 pharmaceutical companies in the US use SERMO to inform and collaborate with physician stakeholders.

Despite raising around $US40 million to fund expansion since its inception, SERMO had struggled to turn a profit prior to its acquisition in 2012 by WorldOne, a healthcare primary market research data collection business.

WorldOne’s strategic thinking behind the purchase was to refocus its primary market-research business into one based on monetising its engagement with healthcare professionals through a medical social network.

SERMO has been making all of its money by offering market research and advertising opportunities to pharmaceutical companies and “others who want to gather real-world opinions from everyday doctors”.

These can take the form of sponsored posts on new medications, products and techniques, or surveys and polls that pay users a small honoraria for completing. On average, SERMO runs 700,000 surveys a year and gives out more than $US16 million ($A21 million) to doctors in honoraria every year.

But it’s the company’s use of doctors’ conversations for marketing purposes that is most controversial. For example, SERMO’s website outlines that its Vital Reports uses the social media platform to, “mine organic physicians’ conversations about drugs, therapeutic areas, disease states and more… to quantify the impact of conversations as they unfold”.

In fact, in December 2009 the company released a report that examined “physician dialogue about diabetes over a one-year period and provides a complete analyses of a variety of topics, including the therapies physicians discuss most frequently, the brands they prefer, and candid/verbatim comments on issues related to diabetes”.

Although SERMO’s Terms of Use state that “SERMO shall be free to use any ideas, concepts, know-how or techniques contained in such information for any purpose whatsoever including, but not limited to, developing, manufacturing, and marketing products and services incorporating such information”, there has been some backlash.

In 2011, a member of the SERMO team, Thomas Rhines, tweeted that as well as research, SERMO “listen[s] to the physicians’ conversations to mine business and competitive intel”. SERMO users took to Twitter voicing their surprise and outrage.

Dr Mark Ryan, a US doctor based in Richmond, Virginia, said on Twitter: “@SermoTeam could have been useful; lack of moderation/professional behaviour limits appeal; data mining kills it for me.”

Other doctors also went online to voice their concerns with SERMO’s conversation mining, with New York doctor Jay Parkinson writing on his blog: “They are spreading their propaganda and spying on us in order to sell more me-too drugs … I already am a member but I don’t use it because I feel like some filthy voyeur is watching me.”

However, many social media outlets mine data for marketing purposes, says Dr Anthony McCosker, Senior Lecturer in Media & Communications at the Faculty of Health, Arts & Design at Swinburne University of Technology.

Transparency is key to the success of this type of marketing, but even so, it can feel more risky or threatening when the interactions are around personal health information, he said.

“With very little exception, social media platforms mine and profit from the activity and conversations of their users. They are all built to both encourage and track the input of marketable data.

“What SERMO offers practitioners is problematic if it isn’t clear that it contributes to marketing efforts. Transparency is vital for these platforms. Practitioners should know who the partner pharmaceutical companies are.

“SERMO does make it clear in its Terms of Service Agreement that patient confidentiality and ethical care around the sharing of private information is the doctor’s responsibility. This is another area of ambiguity. If participants are encouraged to think they are sharing information only amongst themselves, this is misleading and potentially harmful.”

SERMO in Australia 

As SERMO is a doctors-only group, and largely used by anonymous members, The Medical Republic has not been able to get a first-hand report of an Australian doctor regularly using the social platform.

However, speaking to TMR, general practitioner and active Twitter user Dr Tim Senior said that he felt that, if the platform undertakes the same type of data mining in Australia, “there would probably be a backlash” here too.

“From what we read about American medical practice, I wonder if we’re a little less commercialised here in Australia. We’re a little more led to question commercial imperatives than is routine in America – so I wonder if it would therefore be better embraced there than it would here.

“Conversation mining for marketing purposes certainly makes me uncomfortable”, he adds. “I think it creates a lot of mistrust.”

The commercialisation of medical professionals’ intellectual property is also of concern to GP Dr Karen Price, who is also a co-administrator on the popular, non-profit group, GPDU.

“I get the feeling that we’re pretty protective of our spaces as doctors in Australia,” she says.

“We’re not keen on the commercialisation aspects of these things, and certainly not without explicit consent about what it is used for and what kind of remuneration others receive from that data.”

She adds that because GPDU is run “by GPs, for GPs”, and is linked to personal Facebook profiles (rather than being anonymous), it’s well trusted.

“Nothing is without issues but we do try to present as transparently as possible without getting in the way of good discussion. I know that some members would leave if we were to put adverts up on our page, because they would no longer trust us as being a safe environment. Because who would be benefiting? We’ve got our intellectual property on there as a community – there’s peer support and clinical education and networking. Doctors are giving advice altruistically and in a humanitarian sense and the idea that someone could come along and leverage that and benefit from it does not sit well with any of the team of administrators on the GPDU site.”

She adds that SERMO insists that users perform at least one pharma survey a year to maintain the membership, which some doctors may resist and could compound the feeling of mistrust.

Indeed, Dr Senior admits that although he had heard of SERMO, he has not signed up to it because of a lack of trust. He would be further “put off” if he were required to participate in surveys and polls. He doesn’t know anyone who is actually using the platform, and questions SERMO’s figures regarding the number of users in Australia.

He says the claimed “Thirteen thousand is a massive amount [approximately 15% of registered medical practitioners in Australia] and I’m not sure I believe it, to be honest. Certainly among GPs, and GPs that are technically savvy, there aren’t many who are talking about it, so either they [SERMO] are overestimating the figures or they are counting people who registered through some other process, or they have tapped into a completely different set of people who aren’t using other well-known, non-medical social media.

“The reason why Facebook groups work so well is that people are already there, using the network, and you can see who you are conversing with. SERMO would require people to have another online account that they log in to, and you’re not able to see who you are talking to. I’ve found that if I’ve ever wanted to post anything without my name on it, it’s probably not worth posting.”

Dr Senior adds that he is also concerned that anonymous users could promote negativity, for example anti-patient sentiment, or not reflect a user’s true thoughts or medical opinions, and “that’s not very helpful professionally”.

In fact, Dr Senior says the only things that would make him sign up would be if SERMO was offering something unique and valuable he wasn’t already getting from Twitter and [the closed Facebook group] GPs Down Under. Or if he was persuaded by colleagues that it was a valuable space for learning, or patient care. “But I don’t see it happening for the time being”, he says.

To try to get more Aussie doctors to use the platform, SERMO has recently been on a marketing drive – even offering users financial incentives to vote in polls (such as the chance to win $100) and for referring colleagues to the platform.

When asked if this tactic was in reaction to slow take-up in Australia, Kirk emphasised that SERMO is “happy that nearly 13,000 Aussie doctors are benefiting from the network”, but that “sometimes we run promotions to encourage doctors to engage on SERMO.

“We find this brings new voices into the conversation,” he said, adding that he “hopes to see [the number of Australia users] continue to grow”.