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Dinner with Sermo's CEO, Dr. Daniel Palestrant

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Sermo's CEO, Dr. Daniel Palestrant, invited users in New York City out to dinner near Times Square last week. (Sermo is the largest online community for physicians, allowing doctors to ask each other questions, vote on answers, and post comments. Some questions are also asked by clients, primarily Wall Street firms, which pay physicians for their answers through Sermo.)

Palestrant, the CEO and founder of one of the most successful and interesting "Health 2.0" companies, is not what you'd expect. Tieless, youthful, open, engaged, informed, and passionate, he spent four hours nonstop in conversation. If I wasn't already a fan of the community and a believer in Sermo's mission, I was when I stepped out the door at midnight.

The following are brief notes from the dinner.

* The name "Sermo" ("conversation" in Latin) originated when Palestrant was being treated with prednisone for a herniated disk -- "in a steroid psychosis," he joked.

* Sermo had three phases. "Kvetch club," commentary on Paris Hilton, and (now) "useful clinical tool."

* The responses that physicians provide are anonymized. No one -- including Pfizer or other clients of Sermo -- can tell who has voted in a particular way. He was very clear on this. (Comments on posts are a different story. These can be traced back to individuals and their self-provided profiles.)

* Palestrant apologized and took full responsibility for the previously circulated screenshots which appeared to show that clients could view the results of individual physicians. That was apparently a mistake, as the information was actually anonymized. "We were a rookie company," he said.

* We talked about how physicians have lost their market power and have been unwilling, unable, or unaccustomed to sharing information.

* "The United States health care system is larger than the economy of China and it's a cottage industry."

* As has been reported everywhere, Pfizer is now partnering with Sermo, which some users have found controversial. Palestrant explained the move by saying that both physicians and companies like Pfizer have been looking for new (and less expensive) alternatives to drug reps visiting physicians in their offices. And since Pfizer and other companies already employ doctors who visit Sermo, this would at least allow industry doctors to be clearly labeled.

* Pfizer and other companies would also be at risk of having their products criticized by the Sermo community. These criticisms could not be removed by the companies.

* I sensed that, partially in response to concerns over its arrangement with Pfizer, Sermo is about to become even more radically transparent. Palestrant said that they plan to divide the message boards into two groups: one with posts by physicians only, the other with posts by clients.

* Sponsored posts make up only 2% of Sermo.

* Sermo posts will soon be linked to clinical guidelines (through "hotspots"), which users can then comment and vote on.

* Palestrant likes Medgadget.

* Palestrant provided a few examples of problems that were noticed by the Sermo community before the mainstream media -- problems with certain models of pacemakers, for example, and generic Wellbutrin.

* 50% of physicians on Sermo are over 45. This is stunning, considering the demographic of the typical web user.

* For a lot of physicians, especially for those not in academic communities, Sermo functions as a virtual doctor's lounge or grand rounds.

* They've timed it so physicians can post to Sermo in 50 seconds or less.

* We spoke about ways of visually presenting complicated threads of comments from users with different rankings. I mentioned Slashdot. He said that Paul Resnick, who has analyzed Slashdot, is analyzing Sermo.

* Sermo takes pains not to censor the posts of individual users. However, in certain cases, they've consulted with ethicists at the University of Pennsylvania.

* And lastly, Sermo is run entirely on Macs.

As someone who's been involved with online communities for over two decades, I appreciate the difficulty in creating one that works. (In a tangent, Palestrant and I spoke about Cory Doctorow's comparison of online communities to nuclear reactors that are always in danger of melting down.) Having spent time with Daniel Palestrant, I'm convinced he actually knows what he's talking about. And that's important, because the community is walking a fine line. On one side are physicians who are fiercely independent and suspicious of outside influence; on the other are pharmaceutical companies and investment firms which are essential to the business model.

Having met Palestrant, I think that if anyone can make this work, it's probably him. I admire his vision for the community, and I'm interested in where Sermo will go next.
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About the Author


MD, FACP, FASN

Dr. Schwimmer's blog explores the intersection of medicine, new technologies, and the Internet.

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