In no particular order

Biosimilars: Products Whose Time Has Come

Last week (Nov 2-3, 2010) FDA held its public hearing on biosimilars to get input on development of these products in the US as they devise a regulatory pathway. There was a variety of opinions expressed by a variety of constituents at the hearing. The most resounding consensus, to me, was that these products require some level of clinical studies, and that post-marketing safety / pharmacovigilance is essential.

Given the great need to cut health care costs and increase access to medicines for patients through better affordability and choice; given our advancements in science and ability to characterize these products as compared to the reference / innovator products; and given the intense focus on development of a regulatory pathway that has patients' best interests (safe and effective products) in mind, it seems to me that biosimilars make sense in the very near future as part of our US medical treatments.

Another critical consensus regarding biosimilars is the need to educate, particularly health care providers and patients, about these products. (More than likely more education is needed about biologics products in general.) In order for biosimilar products to be accepted and commercially viable, the public needs to know what they are (versus traditional drug / generic products), what value they bring and to what diseases, where else they are approved and used in the world, what manufacturers and FDA will do to help ensure biosimilars are safe, how they will be prescribed, what they cost, how the labels will identify these products, how they should be administered and any potential risks, what resources / support are available on these products, and what steps patients / providers can take to help contribute to the knowledge and safety of these products once approved and in use. Comprehensive and user friendly education, information and support on these products will help build advocacy.

Although there are other high bars set for biosimilar manufacturers in addition to the pending regulatory requirements, most likely biosimilar products will get on the market in this country; once a pathway exists, some speculate within several to five or six years for the simpler products already approved in Europe. At first they may be used for new patients going on therapy versus switching a patient from an existing biologic therapy (interchangeability; a whole other area of varying opinion and further complexity).

Biosimilars are possible today because science has progressed, and it continues to do so every day. Let's not stifle innovation in biologics. Let's encourage it. Coupled with personalized medical techniques, there is a bright outlook for more effective, safer and more affordable medical treatments for a wider variety of diseases, and innovator biologics and biosimilars will play a critical role in that evolution. I will do my best to keep myself educated on these products and their regulatory and commercial progress and share my knowledge with family, friends.

Note: these opinions are my own. I am not a regulatory expert, I just happen to know quite a few good ones. Thanks for reading.

Chris

 

Being Work Life Thankful on Labor Day 2010

It's been a beautiful September weekend and it is in fact Labor Day weekend in the US. I've spent most of it golfing; meeting great people on the course, getting good exercise and seeing nice New England woodland scenes. Today I relax at home and get ready for a very busy fall. As I get the laundry done, tend my garden, take time to make some home-made food and chat with my neighbors, I also give thanks for what I have in my personal life and more especially today, in my work life. 

There are many folks out there without a job, or those that abhor their jobs due to any number of issues; sometimes to the serious detriment of their physical and mental health. Others work two or three jobs just to keep a float. We all know someone whose reality is such.

So it is a good day to be grateful for your job, your work, and hopefully your passion; where you spend a good deal of your life. And, if you are small business owner, or an entrepreneur -- thank you for creating new jobs and prosperity for others.

I hope you enjoy what you do, and if you don't please start making some changes to get yourself to a new place or mindset. Rationalize your job in perspective with the rest of your life if it is not a passion, but rather a means to support yourself and have medical insurance. Enjoy your co-workers and social aspects of the job. Take breaks during the day, versus working right through them. Start a new job search and get career counseling if you need advice. Explore educational / training opportunities to reach new career goals. Write a new business plan. And, make sure you are managing for retirement as best you can, so you can look forward to that chapter of your life versus fearing it.

Anyway, thanks for stopping by. Here's to a great fall in your work and personal lives!

Chris

Leveraging Change for a Better Work Life

When change occurs in your life, it is often a time of stress. Things are different in one way or another, and it's not always comfortable, or it brings a level of unexpectedness, a change from the norm you've been living in. I've been thinking about this a lot as I am facing a change in my work life. Here is my plan to approach it.

1). Look upon the opportunity it presents.

2). Take some time to be retrospective and see where you can improve.

3). Reflect on what you've done well, and where you want to go.

4). Find or re-find an outlet you've neglected: art, a new exercise routine, music, volunteering.

5). Refresh relationships, reach out for new ones.

6). Turn the corner with a positive attitude and renewed strength.

7). Relish in the good things change can bring.

Well, I have enjoyed this little pep talk. If you have any short stories of making change positive, leave a comment. And, thanks!

Impact of Social Media on Biopharma IV

Hi everyone.

Well, here is the final portion of this Impact of Social Media on BioPharma series. I am simply going to include some quick new developments in biopharma social media to start, and provide some final SM lists for you from my June DIA poster. 

I am looking forward to doing some regular short commentaries on-going versus these long pieces. This was really a way to get myself started in the blogosphere and share the info I had worked hard on researching. Ah yes, and maybe I can get some help with a better blog design. Anyway hope this is useful.

Cheers!

Roche's Social Media Principles were published in August 2010

http://www.roche.com/social_media_guidelines.pdf

In particuIar see the Roche Social Media Rules in Short broken out by personal and professional.

I think this shows best-practice leadership by Roche in laying proper governance foundation for their new media activities and by their transparency to industry as it tackles use of new media.

I for one found them a great resource as I work to help put together such principles for the businesses I work for/with and fine-tune my own online/mobile personal risk management best practices.

Novartis and Widgets:

Here is an article on the Pharm Exec Blog. Lesson here is that you should always review your meta data when developing online content. SEO and digital vendors may write these for you for example and they usually do so in a way to optimize search results. So they may not be written in a manner acceptable whether you are in pharma or not. Since these are highly visible in Google for example when you do a search, or at the top of your web browser, attention should be paid to them and they should always be part of a final review. of new content pre-launch In the case of pharma cos, they should be looked at by a maketing regulatory compliance expert along with other content. FDA is obviously paying attention.

Finally, below are some final additional lists that you may find useful. As always I recommend Dose of Digital's Pharma and Healthcare Social Media Wiki as a great ongoing data source. Recently Jonathan Richman was looking to add Medical Device companies using social/new media. So if you can add to the list, please visit the site and enter the data. You will be acknowledged as the data source. 

Clinical Trial Information / Screening / Recruitment:

Diabetic Connect (Social networking site)

NexCura (Oncology social networking site)

PatientsLikeMe (Social networking site)

SharingStrength.ca (Breast cancer, social networking site)

We.Are.Us (Social support networks site)

Acurian (Opt-in e-mails and awareness: FB and MySpace)

ClinicalConnection (Trial listing site, Twitter)

Medpedia (Trial listing site, Twitter)

UCSF Medical Ctr. (Trial matching services, FB)

MD Anderson Cancer Center (Trial matching services)

Bubbly (Mobile voice version of Twitter used in India, Brazil)

CISCRP (i-phone app trial matching services)

Primary Data Source: BioITWorld May 2010 (see references)

Mobile:  (select listing):

Epocrates iPhone app  (Product info for docs)

myBETAapp™(iphone app for MS Betaseron®)

i-Heart Pulse Reader App (Cardiovascular)

The Pill.com App (Compliance)

Livehappy.com App (Psychiatry)

WebMD Mobile (Diagnosis)

Pill Phone  (Compliance)

Pill Boxer (Compliance)

Chronic Pain Tracker (Rheumatology)

iHeart Pulse Reader (Cardiovascular)

PureSleep AmbiScience (Insomnia)

Live Happy (Psychiatry)

Quitter (Smoking Cessation)

Pink Reminder (Women’s Health)

Source: Digital IQ Index to Pharma 2010 L2 and IGNITE Health Blog 6/4/2010 on Bayer

FDA Social Media Accounts

1. FDA Animal Health
2. FDA Recalls
3. FDA Drug Information
4. FDA Regulated Medical Devices
5. FDA Women.
6. FDA U-tube Channel
7. FDA Transparency Blog

Personal Healthcare Information Management

(includes Patient / Provider / Pharmacy communications also; source Microsoft Health Vault.com)

1. Microsoft HealthVault
2. yourHealth (Unival)
3. ActivePHR (ActiveHealth Management)
4. Aetna Personal Health Record
5. Alert Notification
    CardioSmart (American College of Cardiology)
6. My Diabetes Health Assessment (American Heart Association and American Stroke Association)
7. Heart360 Cardiovascular Wellness Center (American Heart Association and American Stroke Association)
8. Heart Profilers (American Heart Association and Thomson Reuters)
9. TrialX (Applied Informatics Inc.)
10. ApoThera (Drug Regimen Review)
11. PatientSite (Beth Israel Deaconess)
12. registeR4Health (Citius Tech)
13. CVS CMy CVS/pharmacy Prescriptionsaremark
14. Health Postbox Express (Darena Solutions)
15. Dental Optimizer (Dentists Management Corporation)
16. MyVitalData (Vital Data Technology)
17. Your Walgreens Pharmacy Records
18. SPINNphr (White Pine Systems)
19. US Wellness  (US Wellness)
20. My Family Health Portrait (Surgeon General US Gov)
21. StayWell Online® (StayWell Health Management)
22. TelaDoc  
23. Alliant Health Donor Registry (SmarTek21)

Twitter (Payer/Health Plans)

1. AetnaStudent
2. AnthemHealth
3. AsurisNWHealth
4. BCBS
5. BCBSAlabama
6. BCBSDCEO
7. BCBSDE
8. BCBSIL
9. BCBSLA
10. BCBSMN
11. BCBSNC
12. BCBSNebraska
13. BCBSNebraska
14. BCBSNM
15. BCBSOK
16. BCBSTX
17. BCBSWNY
18. BCBSWNY
19. BlueCrossMN
20. CADMHC
21. CIGNA
22. CignaTweets
23. DelawareBlues
24. eHealthInc
25. ExcellusBCBS
26. GotRegence
27. HarvardPilgrim,(protected) also has letstalkhealthcare.org
28. HCCMIS
29. HealthConnector,(MA)
30. HealthPartners
31. HPMemberService
32. HumanaHelp
33. IBX
34. ISBCBSSC
35. KaiserInsurance
36. KPcolorado
37. LocalHealthPPL
38. MABlueCross
39. McLarenHlthPlan
40. MHPA
41. OAHP
42. RegenceIdaho
43. RegenceOregon
44. RegenceOregon
45. RegenceUtah
46. RegenceWA
47. SelectHealth ,whathaveyoudone.org, protecttoothy.com, selecthealth.org
48. StateHealthPlan,(NC)
49. TRICARE,(Military, not endorsed by military) flickr  u-tube facebook, tricare.mil
50. TriWest Military
51. UnitedHealthGrp,(protected)

Impact of Social Media on Biopharma: Part III

Happy Sunday.

Today I provide some more results of my research into The Impact of Social Media on BioPharma including Qualities of Effective Social Media, How BioPharma is Approaching Social Media, Status of FDA Policy on Internet and Social Media, and Hot Topics / Issues Areas. In my final installation, Part IV, I wll provide a couple current good WPs and a good slide deck as additional, more current resources on this topic and some short lists of other resources that may be of interest.

Enjoy the summer while it's here!

Best, Chris 

Qualities of Effective Social Media:

· Open

· Transparent

· Honest

· A dialogue

· Well-managed and expertly moderated

· Relevant, engaging

· Non-self promotional (unless indicated as so)

· Clear terms and conditions for participation

· Integrated with other channels

· Follows HIPPA, FTC, FDA (and other Regulatory Agencies), Legal guidance and laws, corporate policy and procedure guidelines

· Risk management scenarios thought out and planned for

How BioPharma Approaching Social Media:

· Commitment to be where the conversations are

· Becoming more patient- versus product-driven

· Dipping the toe-in, but behind other industries

· Approaching carefully given highly regulated nature of industry, risk level

· Awaiting anticipated FDA regulations/guidance (2010)

· Learning lessons along the way, often highly publicized and commented upon

· Biopharma companies and organizations actively participated in FDA Social Media Hearing to help FDA create a workable set of rules

· Best practices: one pharma  has commented on how it involved  legal and regulatory early in the SM strategy building process

· Need to market to people vs. patients by understanding their interests and where they go online: Social Technology Profile, Condition Profile, hobbies

· Empowered patients are leading the way! Opportunity abounds!

Status of FDA Policy on Internet and Social Media:

• Dec 2008 promulgated a policy on “Consumer Health Info” with WebMd, in Nov 09 with EverydayHealth and May 2010 with drug.com 
• April 2009 FDA sends FDA/DDMAC Letters to 14 leading drug companies requesting them to end what it's calling "misleading" and "misbranded" advertising on search engines
• FDA does not have specific guidelines for advertising in the digital realm
• Nov 12 -13, 2009 Public Hearing held
• Written or electronic comments, docket FDA-2009-N-0441 accepted until February 28, 2010.
• Draft Guidance Expected by End of 2010

 

Hot Topics / Issues Areas:

•    Adverse  Event reporting

•    Unbranded promotion

•    Off-label promotion

•    Branded versus unbranded sites

•    Need for clear FDA regulations vs. guidance

•    FDA “Seal of Approval” on sites?

•    Apps /widget mechanisms to report Adverse Events

•    A November 2009 Nielsen study found that only 1 in 500 online postings or .2% incorporate the criteria required for adverse event reporting (DIGITAL IQ Index 2010)

•    Data “scraping” by 3rd party monitors; not violating policies of patient social networks or pharma SM policies

•    Is it ethical for pharma marketers to employ "f-patients" (fake patients)

 

The Data Sources and References:

• Pharma and Healthcare Social Media Wiki (this wiki is the place to find or to post any new sites and document properly;  Jonathan Richman @jonmrich, Author Dose of Digital, Dir. Social Media, Bridge WW)
• Edward Bennett's Hospital Stats (detailed data is presented and updated on this site http://ebennett.org)
• 10 Hospital Social Media Success Stories, Tony Chen’s blog
• MHR Manhattan Research; visit www.manhattanresearch.com
• Olivier Laurent, Using Social Media as a Recruitment Tool for Observational Studies, 2010, Coligane Group
• Kantar Health (various), www.kantarhealth.com
• Pew Internet  & American Life Project, 2009
• Digital IQ Index Pharma, May 2010 Prepared by L2
• A Social Approach to Patient Recruitment,  Deborah Borfitz, www.bio-itworld.com, 5/18/2010
• Industry Observers Twitter sites – see my biopharma-sm twitter list on Twitter @chrismlindgren

Note: These observations are strictly my own opinion as researched for a poster presentation at the DIA Annual Meeting June 2010. They are certainly already dated...as this evolution marches on.

Impact of Social Media on Biopharma: Part II

Hi, and good day or evening to you.

 

In this second post on The Impact of Social Media on Biopharma, I cover how various Biopharma / Healthcare constituents are using social media today. See Part I for background on my interest in this topic. Thanks for visting, and please provide any comments or info that can help improve the accuracy of my findings, or supplement them.

 

Best,

 

Chris

June 11, 2010

Manufacturers: Cautious, engaged, parent company more active than brands, non-branded (including sponsored) sites are the more popular sites, awaiting regulations   Reputation management, brand communication Listen and learn from patients Provide product and health information and training as product experts to patients, physicians, others Conduct patient and product / market research Recruit / inform patients for / about clinical trials Provide patient access and support programs Recruit employees Post information about a product recall	Patients: Empowered (100M+ consumers) and usage growing rapidly; this is where it's happening!       Get general health and medical information (e-health consumers) Get drug / product information and (e-pharma consumers – 44% US adults) Get & give support, share experiences, what works, what doesn’t, get honest answers, remove mystery of medical decisions, make informed decisions Find and communicate with providers Rate medicines and providers/hospitals Break through isolation of a chronic illness Group learning through shared experience Find information on a clinical trial for oneself or a loved one Note: patient's condition profile has a significant influence on their Social Media profile
Healthcare Providers / Hospitals: Doctors empowered with smartphones, and their overall SM advocacy and usage growing; subset of hospitals leading the way in their space through creativity and strategic integrated channels   Get the latest update, education on medicines, on the go Collaborate with peers for better patient outcomes Communicate with hospital staff Help identify resources for patients including clinical trials Provide play-by-play account of surgeries Recruit doctors Network with peers, interact with patients and their families Sponsor and provide Social Media sites for patients Get feedback on services provided	U.S. Regulators / Government Health Agencies: Protecting the public health, working on the regulations, using Social Mediums themselves       Protect the public health by Informing public about healthcare and drug safety issues and how to report them  Monitor to manage compliance and safety by industry Drive efficiencies through use of new technology to improve processes and costs Conduct public hearings to gain industry input Develop and publish regulations & guidance relevant to new media Provide more access to accurate medical information via partnerships with select healthcare social media sites
Payers / Health Plans: Supporting healthy lifestyles and customer service     Provide health tips and information Provide information on health screenings Provide customer service Provide insurance information Provide applications for healthcare coverage Listen to patients, provide health monitoring services Provide prescription choices cost decision tools	Social Media Service Providers / Industry Observers: Extremely active analysts / commentators, entrepreneurs, innovative leaders, cross-industry opportunists, thinkers   Help develop strategies and tactics to implement Social Media Provide social media services, technologies, platforms Help moderate and manage social media channels on behalf of clients Provide monitoring services, product and market research Comment on industry developments, influence Create dialogue to shape industry direction Educate others, share resources Provide Personal Health Record services for consumers

Note: Data sources and references that helped me reached these conclusions will be provided in Part III.

Note: This content reflects my own personal opinions based on learnings.

The Impact of BioPharma on Social Media: Part I

For the DIA Annual Meeting this past June 2010, I created a poster on The Impact of Social Media on Biopharma. My main reason for doing the poster was a desire to get myself immersed and up to speed on the subject, and to share what I had learned at the meeting. In the course of doing so I began following some very savvy folks on Twitter and thereby found keen individual insight, proactive groups and rich data sources, all of which I am grateful for. Two folks I point out in particular as sources are Jonathan Richman and Ed Bennett. Most recently Jonathan has continued to move the healthcare social media (#hcsm) focus and conversation forward as evident in his post 10 Things I’d Like to Start Hearing About Pharma Social Media. I have also created a Twitter list called biopharm-sm where I capture the many Twitterers to follow on this subject.

Before it goes to stale, I will provide my top line findings, probably covering them in a couple of posts over the next couple days. I will also provide a link or two to PPTs on Slideshare by key experts that perhaps do a more elegant job than I have in summing it all up. Then I will continue to join my colleagues and peers in propelling the knowledge of, and use of new media forward through strategic, integrated approaches that help provide healthcare value to our society in compliant and rich ways.

Thanks for reading and please share, or add your own two cents.

Chris

Creating & Communicating the Value of Biotech to Healthcare

These days it seems like the only constant is change: companies transforming in the face of globalization, science & technology rapidly advancing, changing regulations and healthcare policies, the social media evolution and its impact on relationships and communications. Bottom line, there’s a lot going on. For biotechnology companies to stay at the top of their game there is always much work to do. By taking a proactive approach, staying informed of market dynamics and outlooks, developing and executing sound strategies and communicating them well, and thinking outside the box, innovative biotech companies can optimize the value of their healthcare products and services.

The Biotechnology industry is serving more and more as the innovation engine for the healthcare industry enriching pipelines and contributing to the development and commercialization of new medical science and technologies that better the human condition globally. The percentage of sales from biotechnology healthcare products within the world’s Top 100 drugs are set to surpass small molecules post 2014 going from 28% in 2008 to 50% by 2014. [1]

But Ernst & Young EMEIA Life Sciences Leader Patrick Flochel says: “Innovation is no longer just about the product — it now encompasses how you do business, who you do business with and how you mobilize your resources to contribute to healthy outcomes for patients.”[2]

And, at a recent industry conference, the BIO-Windhover Pharmaceutical Strategic Outlook held Feb. 24, and as later reported Carlene Olsen in the  Pink Sheet, the conversation turned to the growing importance of not only proof of solid approval milestones but also reimbursement milestones in biopharma deal structures. “We've got to be innovative, not just in the drugs we bring forward, we've got to be innovative in the early stages of drug discovery, and that means taking more risk." said GlaxoSmithKline's Shelagh Wilson, VP and head of the European arm of the company's Center of Excellence for External Drug Discovery. According to the article, E&Y believes that these factors and others are prompting biopharmaceutical companies to broaden their focus from producing new medicines to delivering “healthy outcomes” – a shift that will be driven through creative partnerships and business model innovation.[3]

In October 2009, as Andrew Pollack reported in the New York Times, Google Ventures invested $10 million — into Adimab, a NH-based company with a novel method of generating protein-based drugs. “We’re looking for disruptive and breakthrough technology in a variety of fields,’’ said Bill Maris, a managing partner of Google Ventures. Reported Pollack, still, Maris noted, much of biotechnology now relies on heavy-duty computation, and Google might help Adimab with that aspect of its work.[4]

Thus, by breaking down its own industry silos, through its outreach to other disciplines, and by working to create more cost effective R&D models and proven high value products for patients, Biotech can partner to shape the future of healthcare! It is about people collaborating to innovate in order to help bring value to others. Innovation takes work and its value needs to be communicated!

 

Key ways in which value is created by biotech healthcare:

1. Making personalized and holistic healthcare a reality by understanding the genetic basis of disease and looking at the total patient over their lifetime

2. Enabling more efficient clinical development and safer medicines through diagnostics that can better identify target patient populations and better predict and monitor individual results

3. Developing innovative products with established cost and comparative effectiveness in mind helping to reign in waste in our healthcare systems and increase quality of patient outcomes

4. Providing greater patient access and delivering patient value at all levels of society through business missions and philanthropic efforts of individuals and organizations

5. Sustaining the industry through partnerships and collaboration that keep the industry pipeline healthy

6. Providing expertise and input to governments and key stakeholders that helps shape new regulatory pathways and supports sustainable healthcare transformation

7. Achieving new scientific breakthroughs – treating diseases once thought untreatable lessening the ever-growing toll on health, quality of life and the economy

8. Achieving manufacturing breakthroughs to produce high quality biologic products more efficiently and cost effectively, with the ability to deliver on demand on a global scale and fight epidemics

9. Providing new jobs in a tough economy and seeking sustainable business model solutions with traditional pharma and other industries

10.  Creating a culture that fosters ongoing collaboration and innovation within the biotech industry --connecting tools and development, adopting new financial and partnering models, focusing on treatments and outcomes -- and across scientific, technical and business disciplines such as IT, nanotechnology and telecommunications and new media to bring about a new revolution in healthcare.

Last but not least, Biotech companies must be good marketers and communicators at all stages of product development. They must position their data strategically and have the scientific, regulatory and business savvy to communicate with those that influence their product’s success:  key opinion leaders, key stakeholders and decision-makers, health providers and the public. Biotech healthcare companies must demonstrate how their innovation directly impacts the real lives of everyday people through treatments, cures and better quality of life -- driving the biotech investment engine. And, where biotech companies can demonstrate improvements that also realize greater affordability and accessibility, they should.

If you have specific examples of any of the above, or if you have ideas of your own on this topic, please comment or contact me. I hope to be selected to present on this topic via a poster session at a large upcoming industry conference and such examples would be great to have.  Thank you!

Please note this blog is my personal view & opinion.

---

References:

[1] PAREXEL’s 2009/2010 Bio/Pharmaceutical R&D Statistical Sourcebook, Mark Mathieu, Director of Strategic Research, PAREXEL, editor/author; original data from Evaluate Pharma, April 6, 2009.

[2] Ernst & Young News release: http://www.ey.com/US/en/Newsroom/News-releases/Creative-alliances-with-nontraditional-players-increasingly-essential-for-survival-in-pharmaceutical-industry, Feb 11, 2010

[3] The Pink Sheet: Is Reimbursement A Game Changer For Deal Structures? Industry Execs Weigh In, by Carlene Olsen, March 01, 2010

[4] New York Times Online, Google’s Venture Arm Invests in Biotech Start-Up, by Andrew Pollack http://bits.blogs.nytimes.com/author/andrew-pollack/, October 1, 2009

 

Are B2B and B2C Obsolete in a B2I World?

It seems to me that the terms B2B and B2C are no longer really valid marketing terms. And feel free to straighten me out if I'm wrong; I am looking for dialog here (even though this is my first blog). We are now in an age where most everything from medicine to shopping is ever more highly personalized, where spouses both work and their roles are not so stereotypical, and where most everyone is using the internet in some aspect of their purchasing decisions.

Today marketers market to Individuals; and they market to both their work and life persona's. For example, at work I team with purchasing to choose amongst vendors, and I complain to facilities if the printer isn't meeting our needs. At home I email my sister to recommend a new phone or car. The power of me, the Individual, impacts the decisions and loyalty of both a business and a consumer.

As a marketer I must always think about reaching all those Individuals who are the right fit to purchase my products or who by word-of-mouth impact the decision-making. I need to know them inside and out. I need to know their social technology profile, their interests, their fears and desires.

But just as important or even more so, the ones I really must know -- who they are, where they are, how they work, where they play, who they reach -- are the Influencers that influence them. Those that touch the minds of some, or of millions, at the touch of a key stroke, are critical to my success.

So, have we morphed to a B2I world? Where "I" is Individuals and their Influencers?