Served up by Sermo

Sermo's founder and CEO, Dr. Daniel Palestrant, sent me an invitation to dinner last week. At first I thought it was because of the Medgadget brouhaha, but no. I was singled out simply by geography, as part of his larger plan to informally sit and meet with more Sermo users across the country. Fellow Medgadget scribe Joshua Schwimmer was invited, too.

We didn't know what to expect. I suspected he'd be polite, if only from his previously published correspondence. But what about the rest of the Sermo community, some of whom have distinguished themselves with their comments?

It turns out, we had nothing to fear, and a lot to learn. The Sermo users who showed up to the Midtown restaurant were a diverse mix of academic and private practice physicians, from internal medicine to neurosurgery, men and women, and -- get this -- older. There was no one under 30 in the crowd, and a good number of folks over fifty (plus a septuagenarian professor).

They had some of the same concerns we did about the integrity of the site, and especially about the new deal with Pfizer. Mostly, though, they were curious to hear from the founder about his plans for the community.

Daniel Palestrant impressed us. For all our questions, he was honest about what he knew and didn't know, and he was often able to disclose market research, survey data, and how legal and programming constraints influenced his decisions.

I'd read stuff about the founding of Sermo before, but this was the first time I heard that Sermo's partnership with the FDA stems from negotiations dating back to Sermo's inception. They've also been involved with the bioethicists at Penn, referring questions of conflict since the beginning to people like Art Caplan.

I'd thought that Sermo's business model was essentially to create a forum for doctors, and then sell their aggregated opinions about drugs to investment firms. While that is still fundamentally true, Daniel pointed out a doctor's forum can provide other valuable functions. Already, physicians have started to compare notes about different insurers' reimbursement rates, and a forum like Sermo can bring about more efficient information exchange without risking collusion and anti-trust. The doctors at the negotiating table might not have such a disadvantage next time.

Plus, Sermo forums have been on the forefront of identifying some adverse events that eventually led to FDA advisories and recalls. Granted, they discuss a lot on those forums, so it's easy to be prescient sometimes... but I was thrilled to hear just how they're studying the forums -- which threads generate useful clinical pearls, and how to minimize useless flame-wars (Medgadget has contributed much data to this endeavor). They've brought aboard Paul Resnick to help sort the wheat from the chaff and improve discourse. They're really thinking how to optimize design, and yet are firmly committed to keeping hands-off and not moderating, once the discussion's begun.

When it comes to Pfizer, or for that matter, the AMA -- posts from their representatives will always be clearly marked and well-differentiated from the regular physician comments. And when the docs savage an AMA or drug rep, Sermo won't delete or edit a thing. It's been an eye-opening experience for these 'clients,' but they're determined to adapt, in order to have some interaction with the community. Thankfully, Sermo has determined that client posts can't make up more than 2% of the total, if the community is to flourish.

I was wary that drug reps would find new ways to disarm and undermine comments (and commenters) critical of new drug data -- but Daniel told me I'm underestimating the power of the online physician community.

Moi? But perhaps he's right. I thought I knew a lot about this community, stemming from my blogging activities... now close to four years ago. But while I've been preoccupied with my training, another kind of doctor has ventured online -- one that's a decade or more removed from residency, and eager to recreate that camaraderie and intellectual exchange.

I thought independent bloggers could get the job done, and easily recreate the feel of the physicians lounge -- after all, it's worked for thousands of our readers. But I understood Daniel's meaning when he remarked, "I tried blogging once, but it was too hard."

Practicing alone, doctors have been outmatched by the insurance industry, regulations, and slick pharma reps. But now they're looking to engage these entities, as a group. Sermo quickly figured that out, and capitalized to facilitate the exchange.

That bodes well for Sermo, and probably for physicians as a whole.

Refer Madness

A few years ago, when blogs were new, James Lileks wrote about an experience after his domain's registration expired. He learned about it by accident, while surfing the links at

Anyway, there’s a message on Instapundit telling me my site cannot be found. This is a bit like picking up the New York Times and reading a headline that says JAMES, YOU LEFT YOUR KEYS AT STARBUCKS.

I was reminded of this tonight, when Joshua Schwimmer emailed his new colleagues at Medgadget to let us know about the National Library of Medicine's guidelines for internet citations. Someone at the NLM has helpfully provided some examples for formally citing blogs. They include:

3. Blog with optional full names for authors/editors

Ostrovsky, Michael; Genes, Nicholas; Odell, Timothy; Ostrovsky, Gene, editors. medGadget [blog on the Internet]. El Granada (CA): Medgadget LLC. [2004 Dec] - [cited 2007 May 16]. Available from:

11. Blog title with upper/lowercase letters, special characters

Genes N. blogborygmi: a digest of developments in the life of an emergency medicine resident [Internet]. [place unknown]: Nicholas Genes. [2003 Jun] - [cited 2007 May 16]. Available from:

There are others -- Matthew Holt, Kevin Pho, Kim from Emergiblog, Amy Tenderich, Sid Schwab, Jacob Reider, Thomas Boyle from Code Blue Blog, the aforementioned Joshua Schwimmer, and more -- all make the list (there are many, many ways to cite blogs).

To borrow from Lileks, it's a bit like thumbing through Strunk and White, and seeing the notes you used to pass to classmates held up as the paragon of good grammar.

The flip side of that is, in just a few years, blogs have gone from nerdy novelty to stuffy institution. At least I can take comfort in knowing someone at the NLM reads the same blogs I do.