Category: CyberPsychology, Behavior, & Social Networking Journal Editorials

Social Media is Shifting Power from Advertisers to Consumers

In a recent column,1 Shel Israel opined, ‘‘Social media is not yet a vast wasteland.. But in the world, where changes come at the speed of the Internet, I see danger here.’’

When television was in its infancy, some of its pioneers sought to share fine arts with viewers, but advertisers quickly drove the decision makers to offer low comedy and variety shows. When social media was in its infancy, companies at first talked about listening to their products’ consumers, but now they are talking ‘‘about making social media more transactional rather than conversational.’’

Still, consumers push back, driving advertising budgets and media buys through their social media behavior. By the 2013 Super Bowl, some predict that advertisers will change less liked versions of their TV commercials to different ver- sions later in the game—for the first time making real time changes in the commercial lineup. This is based on the esti- mated 5 million viewers who tweeted or otherwise com- mented on the commercials during the 2012 Super Bowl, for which ads cost an average of $3.5 million.2 With $72 billion in U.S. television ad spending at stake,3 the once fanciful notion of ‘‘interactive TV’’ is becoming reality.

TV is still the primary communications channel for mar- keters, representing a 41% share of major media advertising spending globally in 2011, up from 38% in 2001, when In- ternet advertising was new.4 Advertisers are learning to put their TV commercials online, and it is paying off. Online au- diences watched ads a record breaking 1.3 billion times in the first quarter of 2012, an increase of more than 40% compared to the same period in 2011 and more than 225% compared to the same period in 2010.5

Paying attention to the convergence of TV and social media is critically important to advertisers, as Americans spend 20% of their day watching TV—and many are simultaneously playing with their iPad or iPhone.3 Research shows that 71% of tablet owners go online while watching TV; the extra device will soon not be needed, as all TVs are expected to be connected to the Internet, with more than three fourths of global TV shipments in 2015 having this capability.6

Research is beginning to appear to help advertisers un- derstand these interactions. Hanna et al. describe the social media ‘‘ecosystem’’ of digital and traditional media in their 2011 article.7 Hess et al. explore the interplay of TV, PC, and mobile technologies in the German home.8 And research by Onishi and Manchanda concludes that new and traditional media in Japan act synergistically in terms of market out- comes, with this relationship stronger during the prelaunch versus the postlaunch period for a new product.9

Certainly, more research is needed. Companies such as Bluefin Labs are using analytics to find out how context affects ad ‘‘buzz,’’ while recognizing that some processes are still a mystery. One ad appeared on two shows with similar demographics and ratings, yet one show created eight more times the social-media buzz than the other. Moreover, not everything is controllable, as social media users are not representative of the general population, and 90% of people’s conversations about brands happen offline.3

Experts in this emerging field believe that the relationship between advertisers and consumers is undergoing a funda- mental change. As Bluefin CEO Deb Roy put it, ‘‘Audience members speaking through social media is effectively a shift in power.’’3 Advertisers seeking to put that relationship back on a one way footing through ‘‘shouting’’ in social media ignore this power shift at their peril.
1. Israel S. (2012) Will marketing muck up social media? muck-up-social-media/ (accessed Jul. 15, 2012).
2. Talbot D. (2012) Why viewers could soon control Super Bowl ads. article.aspx?id = 39590 (accessed Jul. 15, 2012).
3. Talbot D. (2011) A social-media decoder. New technology deciphers—and empowers—the millions who talk back to their television through the Web. www.technologyreview .com/printer_friendly_article.aspx?id = 38910 (accessed Jul. 29, 2012).
4. Green A. (2011) Understanding television audiences. Warc best practice. Understanding%20Television%20Audiences,%20September% 202011.pdf (accessed Jul. 29, 2012).
5. Visible measures. Q1 2012 social video advertising report. .pdf (accessed Jul. 29, 2012).
6. Mane S, Thompson K. How does industry buzz translate into real world consumer activity? Early indicators of what this means for advertising. Breakfast_Briefing_with_Ipsos_How_Does_Industry_Buzz_ Translate_into_Real_World_Consumer_Activity.pdf (accessed Jul. 29, 2012).

7. Hanna R, Rohm A, Crittenden VL. We’re all connected: the power of the social media ecosystem. Business Horizons 2011; in press. doi:10.1016/j.bushor.2011.01.007
8. Hess J, Ley B, Ogonowski C, Wan L, Wulf V. Understanding and supporting cross-platform usage in the living room. En- tertainment Computing 2012; 3:37–47.
9. Onishi H, Manchanda P. Marketing activity, blogging and sales. International Journal of Research in Marketing 2012; in press. doi:10.1016/j.ijresmar.2011.11.003


Brenda K. Wiederhold


Citizen Scientists Generate Benefits for Researchers, Educators, Society, and Themselves

What, exactly, is a ‘‘citizen scientist’’? ‘‘The term ‘citizen scientists’ refers to volunteers who participate as    field    assistants    in    scientific    studies.    Citizen    scientists . are not paid for their assistance, nor are they necessarily even scientists.’’1 Two hundred years ago, everyone was a citizen scientist and made their living in another profession. Ben Franklin, who invented the lightning rod and bifocals, made his living as a printer, diplomat, and politician. Contrast that with today’s call from the National Oceanic and Atmospheric Administration National Weather Service to ‘‘Be a Citizen Scientist’’ ( .pdf) and join its network of 230,000 trained severe-weather spotters.

In September 2011, you may have heard that an amazing event occurred: citizen scientists formulated a structure for a key enzyme related to the development of the AIDS virus by using FoldIt,2 an online game in which volunteers can shake, wiggle, or pull apart different pieces of a protein molecule ( It took these gamers a mere 2 years to crack a code that had eluded scientists. What you may not know is that this breakthrough was just the latest contribu- tion by citizen scientists, who are increasingly moving into the life sciences, and that FoldIt was created because of a project called Rosetta@home.3

Rosetta@home, like the more famous SETI@home that sorts through radio signals in the Search for Extraterrestrial Intelligence (SETI), harnessed volunteers’ unused computer power to research complex issues through so-called grid computing. When the volunteers noted to the researchers that they could do a better job of manipulating the molecule than the computer, the researchers developed the FoldIt program, and the rest, as they say, is history.

It is interesting to note that most of the gamers didn’t have sophisticated knowledge of biology, but instead had good spatial reasoning skills—something that is difficult to emulate in a computer program. We don’t know yet whether these successful gamers have increased their knowledge of and improved their attitude toward science, but an earlier study may provide some clues.

Environmental science was one of the first fields to so- licit volunteers in projects such as the National Audubon Society’s Christmas Bird Count, which began in 1900. The Birdhouse Network (TBN) is a more complex citizen scientist project involving the creation of nesting boxes and reporting on the behaviors of cavity-nesting birds such as swallows; interaction with TBN staff is encouraged. In a standardized evaluation of this project, the researchers determined that participants’ knowledge of bird biology increased, but they were unable to detect a significant increase in attitude toward science or the environment, or increased knowledge of the scientific process. As a result, the authors suggested, ‘‘Citizen-science projects that hope to increase understanding of the scientific process should be framed in a way that makes participants particularly aware of the scientific process in which they are becoming involved.’’4

How can we encourage more individuals to become citizen scientists? As we wrote in our last editorial about engaging the public in scientific discourse, how we frame the issue is key. Also important are the software and other tools that make participation easy. Most citizen scientists, such as those now becoming involved in genomic research, derive satis- faction from knowing that researchers will use the data they contribute. Science grant recipients will increasingly find public outreach requirements as a condition of funding, and should welcome the opportunity to engage citizens in a way that encourages participation.

As National Academies of Science researchers put it, ‘‘Citizen science has a number of benefits for four separate communities. For scientific researchers, it allows projects that were previously impossible to be done quickly and easily. For volunteers, it can provide fun, a sense of community, and the ability to contribute to science. For STEM (science, technology, engineering, and mathematics) educators, it can offer the opportunity for in- creased learning, a window into the process of science, and a chance to promote the idea that ‘I can do science.’ For society at large, it can build a closer connection between scientists and the public, and can result in a public with increased knowledge about science and scientific habits of mind.’’5

Given that anyone with Internet access has the potential to serve as a citizen scientist, we think that cybertherapy projects and citizen scientists are a good fit. We hope that you, our CYBER reader, will consider the benefits of engaging citizen scientists to the fullest extent possible in your work as you test and validate new virtual environ- ments and related technologies.

1. Cohn JP. Citizen science: Can volunteers do real research? BioScience 2008; 58:192–7.
2. Gamers succeed where AIDS researchers could not. Inter- national Business News, Sep. 20, 2011. art/services/print.php?articleid = 216916 (accessed Sep. 25, 2011).
3. Bonetta L. New citizens for the life sciences. Cell 2009; 138:1043–5.

4. Brossard D, Lewenstein B, Bonney R. Scientific knowledge and attitude change: The impact of a citizen science pro- ject. International Journal of Science Education 2005; 27: 1099–21.
5. Riddick MJ, Bracey G, Carney K, et al. Citizen science: Status and research directions for the coming decade. AGB Stars and Related Phenomenastro2010: The Astronomy and Astrophysics Decadal Survey, Vol. 2010, p.46P. 2010/DetailFileDisplay.aspx?id = 454 (accessed Sep. 26, 2011).


Brenda K. Wiederhold


Build Trust, Engage People to Increase Understanding of Science

From the 1960s through the mid-1980s, the term ‘‘scien- tific literacy,’’ focused on public knowledge of science, came into vogue. From 1985 to the mid-1990s, the term ‘‘public understanding of science (PUS),’’ focused on public attitudes toward science, became the new paradigm. Both are so-called ‘‘deficit models,’’ in which researchers assume that the public is deficient in knowledge, attitude, or trust. From 1995 to the present, the focus has shifted to the deficits of the scientists in communicating with the public, with public en- gagement the perceived way to rebuild public trust and achieve a social consensus on controversial scientific issues.1 Education is only a part of the solution, as a recent meta- analysis across cultures showed a small positive correlation between knowledge and attitudes.2

The deficit model overlooks the roles of ideology and social identity, as well as the roles of science fiction and entertain- ment on certain topics such as cloning. The public engagement model of the last decade features, for example, consensus conferences in which stakeholders participate in evaluation and decision making.3 However, such engagement may have unintended consequences, such as the formation of a watch- dog advocacy group to monitor nanotechnology in the com- munity.4 A recent analysis of such upstream engagement showed that, with the exception of the UK Nanojury and Nanodialogues, most projects studied by the authors did not go beyond consensus formation or measuring public opinion. However, if people cannot translate participatory approaches into a political process, there could be a backlash, such as that created in Europe against genetically modified food.5

Moreover, the deficit model ignores how people use media to learn about science. In the absence of strong motivation to acquire knowledge, they will use mental shortcuts, person- ally held values, and feelings as a basis for their beliefs about a scientific issue. In addition, people are drawn to new sources of knowledge that reinforce their current beliefs. Certainly, opinion leaders have a talent for providing great ‘‘sound bites’’ that may oversimplify or contradict scientific evidence, such as promising that food biotech will put an end to world hunger.3

There is a need for truthful sound bites, however, as people need to hear about science in ways that make the results personally relevant and meaningful. As scientists, we must learn to focus on framing our messages to connect with di- verse audiences. If we do not, other groups surely will, as the framing of the food biotech issue in Europe as a Pandora’s box of unknown risks helped stall progress on such research in some countries.6

In a new book on science communication, social scientist Matthew Nisbet at American University in Washington, DC, writes:
A generalizable set of factors, principles, and social meanings appear over and over again across science debates. These generalizable features reveal important clues about the inter- section between media frames and audience dispositions, the role of journalistic routines in altering the definition of an is- sue, and how science policy decisions are made. However, in order to put theory and principles into or- ganizations should work with communication researchers to commission surveys, focus groups, and other analyses that can identify effective messages and media platforms. Drawing on the typology of frames presented, on any particular issue, re- search needs to pinpoint the mental associations and cognitive schema that make a complex science topic accessible and personally meaningful for a targeted audience along with the particular framework devices that instantly translate these intended meanings.7

As we identify media platforms for our science messages, we must remember that social networking sites are changing the way that people get their science information. For ex- ample, members of an online community of experts can tweet a critique of a linked article from a peer-reviewed journal to their followers, bloggers may notice and comment on the controversy, and a new online op-ed piece may be created that provides additional context to the reader of the original article. Companies are beginning to take advantage of the social media properties of the Internet via Web sites that link to their Facebook pages and YouTube channels, and feature blogs and discussion groups. Patient advocacy group and special interest group Web sites are intended to frame policy debates or news coverage, and some science blogs blend science with religion.

As clinicians and scientists, we must be vigilant not to feed into the cycle of hype. We must withstand commercial pres- sure, temper our own hopes for a technology in our reporting, and under-promise results to pave the road to public trust and engagement.


1. Bauer MW, Allum N, Miller S. What can we learn from 25 years of PUS survey research? Liberating and expan- ding the agenda. Public Understanding of Science 2007; 16: 79–95.
2. Allum N, Sturgis P, Tabourazi D, Brunton-Smith I. Science knowledge and attitudes across cultures: A meta-analysis. Public Understanding of Science 2008; 17:35–54.

3. Bubela T, Nisbet MC, Borchelt R, Brunger F, Critchley C, Einsiedel E, Geller G, Gupta A, Hampel J, Hyde-Lay R, Jandciu WE, Jones SA, Kolopack P, Lane S, Lougheed T, Nerlick B, Ogbogu U, O’Riordan K, Ouellette C, Spear M, Strauss S, Thavaratnam T, Willemse L, Caulfield T. Science communication reconsidered. Nature 2009; 27:514–18.
4. Powell M, Kleinman DL. Building citizen participation in nanotechnology decision-making: The democratic virtues of the consensus Conference model. Public Understanding of Science 2008; 17:329–48.
5. Kurath M, Gisler P. Informing, involving or engaging? Science communication, in the ages of atom-, bio- and
nanotechnology. Public Understanding of Science 2009;
18:559–73. 6. Nisbet MC, Scheufele DA. The future of public engagement.
The Scientist 2007; 21:38. www.the article/
print/53611/ (accessed September 6, 2011). 7. Nisbet MC. (2010) Framing science: A new paradigm in
public engagement. In Kahlor L, Stout PA, eds. Communicating science: New agenda in communication. New York: Routledge, ch. 2, pp. 40–67.


Brenda K. Wiederhold


What Would Happen If We Treated Scientists Like Rock Stars?

These days, it seems like everybody knows Lady Gaga, but how many know Noam Chomsky who reshaped the field of psychology? A 2010 Research!America survey revealed that 72% of the public can’t name a living scientist. Would it make a difference if we treated scientists like rock stars? Recently, the Geoffrey Beene Foundation and GQ magazine set out to find out.

The December 2010 edition of GQ carried a six-page spread of rockers and scientists designed to help bridge the gap between science and the public. The Rock Stars of Science Web site ( honors 28 ‘‘Roc Docs’’ of 2009–2010. One of the featured physicians, Susan J. Blumenthal, M.D., M.P.A., former U.S. Assistant Surgeon General, has this to say about what scientists and rock stars have in common: ‘‘Rock stars and scientists share passion, creativity, and the thrill of discovery. Where musicians use their minds, instruments, and voices to create new rhythms, researchers use science and technology to make the music of medicine: new discoveries that improve health and eradicate disease.’’

A critic of the Rock Stars of Science campaign1 says that while the goal is connecting science to people and the idea is to see scientists, like rock stars, as ‘‘one of us,’’ the premise is flawed. Rock stars are ‘‘the other,’’ representing a world of fast cars and glamour that may be aspired to but is seldom achieved.

One Rock Stars of Science campaign goal was to increase funding for scientific research and, for a number of reasons, that goal may be realized. President Obama’s FY 2012 budget contains a 6% increase for federal research and development, which is in line with the support this President has shown for basic and applied science throughout his presidency.

Another campaign goal, to inspire young people to pursue scientific careers, may be more elusive. A November 2010 column2 reported the reaction of Sofya Low, a public high school math and science teacher: ‘‘They’re asking kids to go to this website, process that they like Timbaland and then that he’s standing with scientists, read that the scientists study Alzheimer’s, figure out what that is, and then see how that’s exciting. I just don’t see it happening with teenagers and their 20-second attention spans.’’ Her students don’t per- ceive science as glamorous and well-paying, so science needs to be interesting in a fundamental way to attract their attention.

Although some scientists, such as Stephen Hawking, have a knack for making science interesting to the public and generating media interest, many scientists may be uncom- fortable in the spotlight. Communicating with the public is now considered a scientist’s responsibility. For scientists un- accustomed to speaking before lay audiences, programs such as the Aldo Leopold Leadership Program at Oregon State University exist. They train scientists on how to talk to the media, testify before Congress, and communicate effectively with business leaders.

A recent paper acknowledges that scientists have ‘‘a growing recognition that effective communication requires initiatives that sponsor dialogue, trust, relationships, and public participation across a diversity of social settings and media platforms.’’3 The authors concluded that if people feel they are being marketed to, trust erodes, and recommended that scientists find ways to engage the public that respect ‘‘differences in knowledge, values, perspectives, and goals.’’



1. McGannS.RockStarsofScience.RefractiveIndex2011(Feb14). of-rock-stars-of-science (accessed June 25, 2011).

2. Maxmen A. Scientists as rock stars? They pose with famous musicians to excite the public about science, but not everyone thinks it’s working. The Scientist 2010 (Nov 17). http://classic (accessed June 25, 2011).

3. Nisbet MC, Scheufele DA. What’s next for science commu- nication? Promising directions and lingering distractions. American Journal of Botany 2009; 96:1767–1778.


Brenda K. Wiederhold


Should Adult Sexting Be Considered for the DSM?

In the wake of the news about the unfortunate events that led to the resignation of Anthony Weiner, aged 46, from the U.S. House of Representatives, we ask: Should adult sexting be considered a deviant behavior worthy of inclusion in the DSM?

Former Rep. Weiner’s fall from grace began when he ac- cidentally posted a link to a lewd photo of himself on a Twitter account that he used to communicate with constituents. He subsequently admitted that he had been sexting both photographs and messages to various women before and during his marriage.

Sexting can be defined as ‘‘sending, receiving, or for- warding sexually explicit messages, photographs, or images via cell phone, computer, or other digital devices.’’1 To date, much of the research has focused on adolescents and young adults, the age group most involved in this activity.

An online survey of undergraduate students found that nearly two-thirds had sexted nude or semi-nude pictures of themselves, mostly to their boyfriend or girlfriend. About a quarter sexted someone they wanted to hook up with or date, and 15% sexted people they had met online only.2 While being sexy or initiating sex were the primary motivations of this group, an earlier pencil-and-paper survey by this same author found that self-expression was a primary motivation.3

Some authors place sexting in the category of cyberbullying,4 which it certainly can be when used by adolescents to harass other teens. But what about adults? Do we know anything about why adults use sexting and if it is associated with other high-risk sexual behaviors?

To date, research to answer this question is limited. One study of young, mostly Hispanic older adolescents and young adults aged 16–25 found that 20% used sexting. The women who used it were slightly more likely to enjoy sex and slightly more likely to exhibit histrionic behavior.5

Perhaps it is just that some politicians lack the internal controls, such as conscience, or the external controls, such as police, to guard against what may be perceived as deviant behavior. Sexting among consenting adults is not a crime, and some adults would not consider sexting with a person other than a spouse ‘‘cheating’’ in a marriage. Others, however, might think that such behavior is a sign of a sex addict. Is it deviant behavior? Is it any different from watching porn movies, with or without your partner?

Mr. Weiner’s lapse of judgment brought to light that, in the age of Facebook and Twitter, cyber privacy cannot be guaranteed. Moreover, as clinical and research professionals, we need to be mindful that other issues may contribute to the reasons why some of our adult clients may engage in sexting.

We believe there is a need for more research on adult sexting. What drives people who are married or in a committed relationship to text sexual messages and photos to someone other than their spouse? Does this behavior vary by gender and age? We need to understand the etiology of and treatment options appropriate for such behaviors.

In the relatively new field of cyberpsychology, we strive to learn about the many challenges of current behavior that social networking makes possible. Certainly, such research will help us to prepare for the many behavioral changes that advances in interactive technology will inspire.


1. O’Keefe GS, Clarke-Pearson K, Council on Communication and Media. The impact of social media on children, adoles- cents, and families. Pediatrics 2011; 127:800–804.
2. Henderson L. Sexting and sexual relationships among teens and young adults. McNair Scholars Research Journal 2011; 7:31–39. vol7/iss1/9 (accessed June 26, 2011).
3. Henderson L. Sexting: Self-expression or sexual attention. Boise State University, 2010 Undergraduate Conference, College of Social Sciences and Public Affairs. Poster presentation. http:// (accessed June 26, 2011).
4. Newey KA, Magson N. A critical review of the current cyber bullying research: Definitional, theoretical and methodologi- cal issues. Where do we go from here? Conference Proceed- ings, Australian Association for Research in Education (AARE) International Education Research Conference, Mel- bourne, Nov 28–Dec 2, 2010. 2521NeweyMagson.pdf (accessed June 26, 2011).
5. Ferguson CJ. Sexting behaviors among young Hispanic women: Incidence and association with other high-risk sexual behaviors. The Psychiatric quarterly 2010 [Epub ahead of print] PMID: 21153441.


Brenda K. Wiederhold


CyberPsychology Behavior & Social Networking

Who Gets Funding? Let the People Decide

In The Department of Mad Scientists,1 Michael Belfiore offers a glimpse into the workings of the maverick Defense Advanced Research Projects Agency (DARPA), which is re- sponsible for the birth of the Internet and GPS, among other amazing inventions. The small percentage of Americans who know about DARPA may have heard about it because it funds the Grand Challenge Race, with a $2 million prize for the first autonomous robot that makes it through a desert course, avoiding obstacles and following the rules.

‘‘One enormous continuing development is the exponen- tial growth of social networking media and the increasing use of social media by companies to crowdsource ideas, mount contests to award prizes and gather audiences, and attempt to create dialogues with customers,’’ wrote Rosabeth Moss Kanter in her syndicated column toward the end of 2010.2 The following examples illustrate how these new types of contests can work, and provide food for thought about new possi- bilities for research and development funding.

In 2010, Google awarded a total of $10 million to five finalists in its Project 10^100 contest, which solicited ideas for changing the world by helping as many people as possible. From 150,000 ideas submitted by people in 170 countries, Google selected 16 big ideas and let people vote for their favorites.

The Pepsi Refresh Project is looking for great ideas that are going to ‘‘refresh the world.’’ As with traditional grant funding, there are specific grant cycles, applications, and ca- tegories for projects costing from $5,000 to $50,000. What is new is that the project director gets to promote his/her pro- ject through videos and social media such as Twitter and Facebook, and the projects that garner the most votes win. Pepsi awards up to $1.2 million each month for such projects.

A 2011 contest sponsored by Enterprise Rent a Car was called Giving Back. It allowed visitors to its Facebook page to decide among 10 competing charities nominated by En- terprise employees. The first-place winner received $10,000, the second-place winner received $5,000, and the third- and fourth-place winners received $2,500 each. The contest gave Enterprise Rent a Car an opportunity to promote its foun- dation, which gives 75% of its funds to employee-suggested charities.

Talking about the Dockers ‘‘Wear the Pants’’ contest, in which entrants submitted a 400-word business plan and awards were made on the basis of votes from both commu- nity members and a panel of judges, one author3 offers tips for businesses wishing to engage in social media contests:

  •  The best prizes positively affect people’s lives, creating a positive association for the company.
  •  If everyone gets something (e.g., a coupon) for partici- pating, it helps everyone feel included.
  •  Associating with a good cause generates emotional ap- peal and a reason to spread the word.
  •  Running a contest through Facebook keeps visitors there longer, interacting with the company and each other.
  • A ‘‘soft sell’’ approach that mixes branding, sales, and
    contest strategy is appropriate for social media.
  • Identifying how the contest fits into the marketing strategy, devoting sufficient resources, and defining what a successful outcome looks like are essential to thecontest’s success.

CYBER readers may be interested in the results of a recent study,4 which identified seven key components to informa- tion communication and technology (ICT) competitions:

1. Challenge goal—what sponsors hope to achieve (e.g., prompt innovative thinking);
2. Marketing—howandtowhomsponsorsspreadtheword (e.g., conferences, Web site, social networking sites);
3. Application process—how entries are submitted (most are publicly available);
4. Judging criteria—what is used to evaluate applicants (e.g., originality, economic viability);
5. Judging process—the particular mix that determines winners (e.g., external experts, crowdsourcing, presen- tations);
6. Winners—recent winners and their topics (e.g., mobile apps);
7. Supplemental support—what additional support is of- fered to winners (e.g., coaching for pitching ideas to investors).

The authors of this study concluded, ‘‘In general, contests are increasingly being used as a tool to solve society’s most entrenched problems.’’

This leads us to suggest that more government agencies follow DARPA’s lead. Why shouldn’t governments hold con- tests that let the people decide which projects are funded? This could start small, with perhaps one percent of government re- search and development funding allocated to such contests. In these days of American Idol voting and social media-based contests, we suggest that U.S. and European government agencies consider the benefits of letting the people decide.

1. Belfiore M. (2009) The Department of Mad Scientists: How DARPA Is Remaking Our World, from the Internet to Artificial Limbs. Washington, DC: Smithsonian.
2. Kanter RM. A promising year for technology and innovation. Harvard Business Review 2010; T19:20:43Z.

3. Cotriss D. Social Campaign Shows the Power of Contests. Small Business Trends, April 21, 2011. 2011/04/social-campaign-shows-the-power-of-contests.html (accessed May 10, 2011).
4. Arabella Philanthropic Investment Advisors. (2009) Media, in- formation and communication contests: an analysis. Presented to John S. and James L. Knight Foundation. www.knightfoundation .org/dotAsset/356025.pdf (accessed May 10, 2011).


Brenda K. Wiederhold


What Will It Take to Get IRB Reform?

Although many voices are joining together to call for reform of regulations governing institutional review board (IRB) oversight of research involving human subjects— and some of those voices even agree on how the IRB process should be reformed—progress in the United States toward such reforms is glacial. Unfortunately, the foot-dragging on reform may be costing the United States its leadership role in health research.

Current U.S. regulations governing protection of human subjects have their roots in the 1960s and especially the 1970s, when the National Research Act became law in 1974, spurred by the publicity surrounding the Tuskegee Syphilis Study. In that famous study of black males observed from 1932 to 1972, investigators denied penicillin to infected men. The National Research Act prompted the creation of the National Com- mission for the Protection of Human Subjects of Biomedical and Behavioral Research.1

Now, almost 40 years after enactment of that law, the U.S. health system is evolving faster than the rules to govern it. For example, how do we best regulate comparative effectiveness research (CER)? CER is a hybrid of both clinical trial research, which requires an IRB, and quality improvement processes, which are typically IRB exempt.

Electronic medical records also present a challenge. For example, the President’s Council of Advisors on Science and Technology recently released a report2 that on the one hand recommends personally determined data tagging and stres- ses the need for privacy safeguards, while on the other hand advocating the recommendation of the recent Institute of Medicine report3 to permit greater access to health data to facilitate research.

It is no wonder that the U.S. government provides incon- sistent recommendations. In addition to the Food and Drug Administration, 19 other federal agencies are involved in oversight for protection of study participants. There are more than 6,000 IRBs registered with the Department of Health and Human Services.

Inconsistent outcomes appear to be increasingly likely when the same protocol is presented to different local IRBs, as is common in a multicenter trial.4,5 One study of 88 pediatric practices found that local IRB review appears to be a barrier to participation in research, ‘‘may discourage the inclusion of minority and urban patients, and seems to result in little if any significant change’’ in the (minimal risk) protocols.6 Pogorzelska et al.7 are among the many calling for local IRB reform, including clarification of spe- cific purposes of local review (e.g., ensuring cultural ap- propriateness), assurances that IRB members are trained in regulatory requirements, as well as ethical principles of
research, and consideration of central review mechanisms. This latter is perhaps the most controversial, as national, independent IRBs have been reviewing federally funded research only since 1996.

Five concerns with using an independent IRB are: (a) a perception of increased risk to the institution; (b) possible conflicts of interest among the sponsor, site, investigator, IRB, and IRB member; (c) the importance of local knowledge; (d) logistics between the IRB and the site; and (e) the cost of administrative support. Coleman8 opines that careful evalu- ation of the following factors will lead to appropriate use of independent IRBs: ‘‘the IRB’s reputation and references; composition of the board committee(s) and qualifications of committee members; access to scientific experts; accreditation status; support staff quantity, qualifications, and training; results of regulatory inspections; approval stringency and typical letters; meeting frequency; operational metrics, such as review times; and operating procedures, such as internal auditing and error handling.’’

Regardless of whether a local or independent IRB is used, some say that IRBs concentrate on the wrong things and consequently do not do a good job of protecting the patient. A small    e-mail    survey    (N = 28)    of    principal    investigators9    re- vealed that respondent PIs felt that consent forms were in- comprehensible, that IRBs focused on minutiae, and that they were more concerned with protecting the institution than the subjects. Problem areas and solutions proposed by the In- fectious Diseases Society of America10 not referenced earlier in this editorial include:

  •  Health Insurance Portability and Accountability Act (HIPAA): Remove research from list of HIPAA-covered activities;
  •  Studies including children: Provide updated guidance for key terms, make national review outcomes available and streamline the process;
  • Office of Human Research Protection: Provide increased funding and a clear mandate to produce timely updates in guidance and review.

Another suggestion made by Kim et al.11 is to stop regu- lating minimal risk research, which represents 41% of all new protocols reviewed by U.S. medical center IRBs at a cost of about $300,000 per year for each review.
Many of the solutions suggested by our colleagues are regulatory, not requiring legislation but having the force of law when implemented. Therefore, we urge President Obama to make speedy IRB reform a priority of his administration.

1. Khin-Maung-Gyi F. Local and central IRBs: a single mission. Virtual Mentor 2009; 11:317–20.

2. Executive Office of the President, President’s Council of Advisors on Science and Technology. (2010) Report to the President—Realizing the full potential of health informa- tion technology to improve healthcare for Americans: the path forward. microsites/ostp/pcast-health-it-report.pdf (accessed Mar. 29, 2011).

3. IOM (Institute of Medicine). (2009) Beyond the HIPAA privacy rule: enhancing privacy, improving health through research. Washington, DC: The National Academies Press.

4. Helfand BT, Mongiu AK, Roehrborn CG, et al., MIST Investigators. Variation in institutional review board re- sponses to a standard protocol for a multicenter random- ized, controlled surgical trial. Journal of Urology 2009; 181:2675–9.

5. Stark AR, Tyson JE, Hibberd PL. Variation among insti- tutional review board in evaluating the design of a multi- center randomized trial. Journal of Perinatology 2010; 30: 163–9.

6. Finch SA, Barkin SL, Wasserman RC, et al. Effects of local institutional review board review on participation in na- tional practice-based research network studies. Archives of Pediatrics & Adolescent Medicine 2009; 163:1130–4.

7. Pogorzelska M, Stone PW, Cohn EG, et al. Changes in the institutional review board submission process for multicenter

8. Coleman S. Alternative IRB review. Journal of Clinical Re- search Best Practices 2009; 5(4). journal/2009/0904_Alternative.pdf (accessed Mar. 29, 2011).

9. Whitney SN, Alcser K, Schneider CE, et al. Principal inves- tigator views of the IRB system. International Journal of Medical Sciences 2008; 5:68–72.

10. Infectious Diseases Society of America. Grinding to a halt: the effects of the increasing regulatory burden on research and quality improvement efforts. Clinical & Infectious Dis- eases 2009; 49:328–35.

11. Kim S, Ubel P, De Vries R. Pruning the regulatory tree. Nature 2009; 457:534–5.


Brenda K. Wiederhold


Investment in Innovation: Lessons Learned from China

Investment in Innovation: Lessons Learned from China

President Obama was right to focus on innovation and job creation in his January 2011 State of the Union speech. There is a need to create and fill new jobs in an increasingly competitive global marketplace, and investments in innova- tion will enable businesses using virtual reality and other healthcare technology to be part of a new, much-needed job creation engine.

If U.S. government funding for innovation and education does not increase, China may eclipse the United States in research and development funding within the next 20 years.1 By August 2010, China’s economy had surpassed that of Ja- pan, positioning it as the second-largest economy behind the United States. Some predict that China’s economy will sur- pass that of the United States as early as 2017.2

The United States has enjoyed dominance in innovation for the past 40 years, but that landscape is changing quickly with the globalization of R&D. Not just China but Korea, India, Russia, and Brazil are all investing in R&D at higher rates than the United States, Germany, and Japan.1 Relatively high labor costs in the European Union presage low R&D invest- ments over the next decade, with southern EU states such as Greece, Italy, and Spain investing at a lower rate than their northern counterparts.

Another result of R&D globalization is a reversal of the flow of funds, now flowing from some less developed to more developed countries. For example, China has made investments outside the country in telecommunications, as has India in pharmaceuticals.1

China’s leaders understand the importance of R&D. ‘‘Eight of the nine members of China’s Standing Committee of the Political Bureau, including China’s current President Hu Jintao, have engineering degrees. Of the 15 U.S. cabinet members, only one, Secretary of Energy Steven Chu, has a technical degree—a doctorate in physics.’’3 Consequently, the Chinese government has an innovation policy designed to encourage Chinese companies to create and own tech- nologies. The policy also encourages technology transfer from abroad and establishment of Chinese R&D facilities in exchange for foreign company access to China’s high- volume markets. As a result, a number of multinational technology and pharmaceutical companies have taken ad- vantage of this policy, some transferring facilities from India.

The Chinese government owns all top-ranked academies, including universities, and has tripled its investment in ed- ucation in the past 12 years.3 Of the five million students graduating per year, about one million are research students.

Furthermore, China’s academicians file more patent appli- cations than those in any other country—16% compared to 4% in the United States.

In addition, the Chinese government plays a direct role in investing in 150 companies, providing 27% of their funding in 2007, the latest year for which data are available.3 Universities partner with industry, and about the half the universities’ R&D funding, primary in technology transfer, comes from industry.

In the United States, a recent survey shows that venture capitalists expect their industry to decline over the next 5 years.4 VCs in France, Israel, and the UK also predict a drop, while those in China, Brazil, and India expect growth. What is most discouraging for U.S. business is that most U.S. VCs expect the available amount of venture capital to decrease by at least 30%.

In the United States, small companies—those most in need of venture capital—perform 19% of the nation’s R&D.5 Over the past 25 years, the most dramatic growth in U.S. federal R&D spending has been in health, which accounted for 52% of nondefense R&D in FY2008.

Given the data cited in this editorial, it should come as no surprise that China, India, and Brazil may surpass the United States in innovative healthcare delivery over the next de- cade.6 The United States has the patient populations neces- sary for research, but the rate of growth in financial support and education of researchers has not kept pace with that of developing countries.

President Obama has declared ‘‘innovation in healthcare’’ one of three national priorities for FY2012. With Congress unlikely to approve any initiative that adds to the federal budget deficit, can he deliver on his promises of increased funds for innovation and education?


1. Battelle. 2011 Global R&D Funding Forecast. R&D Magazine 2010 (Dec), p. 24. Featured_Articles/2010/12/GFF2010_FINAL_REV_small.pdf (accessed Jan. 30, 2011).
2. Euromonitor International. Top 10 largest economies in 2020. Euromonitor Global Market Research Blog 2010 (Jul 7). http:// economies-in-2020.html (accessed Jan. 30, 2011).
3. Battelle. 2011 Global R&D Funding Forecast. R&D Magazine 2010 (Dec), pp. 27–29. Featured_Articles/2010/12/GFF2010_FINAL_REV_small.pdf (accessed Jan. 30, 2011).
4. Smith R. Venture capitalists in U.S. expect VC industry, funding to shrink. Local Tech Wire 2010 (Jul 14). http:// post/7959577/ (accessed Jan. 30, 2011).
5. National Science Board. Chapter 4. Research and Develop- ment: National Trends and International Linkages. In Na- tional Science Foundation, Division of Science Resources Statistics, Science and Engineering Indicators: 2010, p. 4-4.
6. (accessed Jan. 30, 2011). PwC Medical Technology Innovation Scorecard Highlights. www innovation-scorecard/index.jhtml (accessed Jan. 30, 2011).
Brenda K. Wiederhold


What Are the True Costs of Regulation

What Are the True Costs of Regulation?


Many researchers and clinicians working in cybertherapy create their own businesses, which allow them to protect their intellectual property. In the United States, small businesses create the majority of jobs but bear proportionally more of the cost burden of implementing laws and regulations than do larger companies. This is true primarily because larger companies enjoy economies of scale. However, estimates of the true costs of regulation vary widely.

A new study* found that companies with fewer than 20 employees pay 42% more per employee than companies with between 20 and 499 employees, and 36% more than companies with 500 or more employees. For small businesses, the average cost per employee was $10,585 compared to $7,454 for medium-sized and $7,755 for large businesses.

According to the study, environmental regulations cost 364% more in small versus large companies, and tax compliance
is 206% higher. Occupational safety and health and homeland security are other top cost drivers.

The researchers calculated that some types of industry pay more than others. For example, small manufacturers (such as small manufacturers of medical devices) pay 110% more for compliance than medium-sized manufacturers and 125% more than large manufacturers. Small health-care firms (such as cybertherapy clinics) pay 45% more than medium firms and 28% more than large firms.

The authors say the total cost of regulation is $1.75 trillion, and note that businesses must close shop, reallocate activity, absorb the cost, or pass on the costs to customers. They estimate the per-household cost of federal regulation and taxes at $37,962.

The report notes, ‘‘If federal regulations place a differentially large cost on small business, this potentially causes inefficiencies in the structure of American enterprises and the relocation of production facilities to less regulated countries, and adversely affects the international competitiveness of domestically produced American products and services.’’

Some say that the above numbers are inflated and the study methodology is questionable, pointing to the annual report of the Office of Management and Budget (OMB) on the costs and benefits of regulation for a truer picture of the cost of regulation.

The OMB report notes that ‘‘The estimated annual benefits of major Federal regulations reviewed by OMB from October 1, 1999, to September 30, 2009, for which agencies estimated and monetized both benefits and costs, are in the aggregate between $128 billion and $616 billion, while the estimated annual costs are in the aggregate between $43 billion and $55 billion,’’ and that ‘‘Most rules have net benefits, but some rules have net costs.’’

Regardless of which of these estimates is closer to the true cost of regulation, the truth is that many regulatory costs are fixed: they are the same whether a company has 20 employees or 20,000. And the 89% of U.S. companies that have fewer than 20 employees produce a significant number of innovations. As President Obama has said, ‘‘Small businesses are the heart of the American economy.’’

In fall 2010, President Obama signed the Small Business Jobs Act, designed to help small businesses have easier access to credit and to provide more tax breaks. While a worthy effort, it does nothing to stem the tide of ever more regulation coming out of Washington.

Regulation per se is neither good nor bad. Rather, regulation in which the benefit outweighs the cost is good; regulation in which the cost outweighs the benefit is bad. Not all benefits can be quantified, which further complicates the picture.

It is time to start a serious dialog about the true cost of regulation, one that uses methodologically sound benefit–cost ratios as a starting point. I encourage readers to become involved in commenting on proposed regulations, so that only those regulations that pass the benefit–cost test are implemented. It is important to do so: the very future of innovation in health technology is at stake.

                                                                                                                                                                                                         Brenda K. Wiederhold


PTSD Threatens Global Economies

Recent news reports reveal the tip of an iceberg that is threatening to sink the ship of state in countries worldwide— the iceberg known as posttraumatic stress disorder (PTSD). PTSD increasingly threatens to swamp health systems and social support systems, even as some of these budgets are cut for lack of funds as a result of the global economic crisis. The human toll is even more devastating.

  • On May 12, 2009, the Associated Press (AP) reported that a 44-year-old U.S. sergeant, nearing the end of his third tour in Iraq, was so angry at the Army he opened fire in the combat-stress clinic in Baghdad, killing five people.
  • On May 22, 2009, AP related the story of a 24-year-old ex-soldier on trial in Kentucky for raping a 14-year-old Iraqi girl and murdering her parents and sister while on duty in Iraq. The jury cannot agree whether or not to sentence him to death.

It is probable we will see more headlines like these in the next 6 months because the U.S. Army will not be able to give soldiers adequate time at home between tours of duty until the end of 2010. Since 2001, the U.S. has deployed nearly 1 million soldiers to Iraq and Afghanistan, and more than 300,000 of them have served multiple tours. About 20% of these soldiers return with psychological damage, most commonly PTSD and depression. At least half of PTSD sufferers smoke, and others become dependent on alcohol or prescription drugs. PTSD increases risk of cardiovascular disease, and multiple traumas have a deleterious effect on many aspects of physical health. Overall, the U.S. Army’s suicide rate reached an all-time high in 2008. For those who survive, lifetime benefits for a U.S. service member permanently disabled because of PTSD may top $1 million. Finally, the most recent estimate of the annual cost of anxiety disorders in the United States, with PTSD ranking highest in terms of per-person health care expenditures, was $42.3 billion in mental and physical health services alone.

In Europe, about 41 million people have anxiety disorders, and PTSD may occur in up to 37% of those exposed to trauma such as combat, sexual and physical assault, being held hostage or imprisoned, terrorism, torture, natural and manmade disasters, accidents, and receiving a diagnosis of a life-threatening illness.

Because PTSD has such varied symptoms, a combination of treatments is often necessary. Anxiety-reducing medications, antidepressants, support from friends and family, and cognitive-behavioral therapy (CBT) involving exposure can help with recovery. However, these types of traditional therapies do not have acceptable recovery rates. Front-line antidepressant medications for the disorder—such as selective serotonin reuptake inhibitors—rarely yield better than a 40% reduction in symptoms. Traditional psychotherapy fares only slightly better, with only 44% of all those entering treatment classified as improved at the end of the treatment period.

Fortunately, we live in a time when advances in medical technology abound. A recent Google search of ‘‘PTSD technology issues 2009’’ revealed that two of the five top links addressed the value of virtual reality (VR) therapy for PTSD.

A panel of experts has published a consensus opinion that exposure therapy is the most appropriate therapy for PTSD. Prior to the availability of VR therapy applications, the existing standard of care for PTSD was imaginal exposure therapy in which patients ‘‘relive’’ the traumatic event in a graded and repeated process. Exposure therapy is based on emotional processing theory (EPT). Applying EPT to PTSD, fear memories are stored as a ‘‘fear structure’’ and include psychological and physiological information about stimuli, meaning, and responses. Once accessed and emotionally engaged, the structure is open to modification through CBT, and over time, treatment will result in extinction of the fear response.

Although exposure therapy has been shown to be effective, one hallmark of PTSD is avoiding reminders of the trauma. Because of this, many patients are unable or unwilling to visualize the traumatic event during imaginal therapy. In studies that address treatment nonresponders, failure to engage emotionally or visualize well enough to elicit an emotional response are cited as most predictive of nonresponse to treatment, since the fear structure is not accessed during therapy and is therefore not open to change.

This is where VR can step in to enhance treatment. In recent years, VR has been shown to improve treatment efficacy for PTSD in survivors of many types of trauma, including motor vehicle accidents, war, earthquake, and terrorism such as the 9=11 World Trade Center attacks. By being placed in an environment where a trauma has occurred (in war veterans, it could be a virtual combat setting; in armed conflict survivors, a virtual countryside under attack), and then slowly experiencing that situation in a controlled way, patients may begin to habituate to the PTSD symptoms and come to reappraise the instigating situation. This allows emotional processing to occur and may free PTSD sufferers from their intrusive memories and disturbing symptoms. Unlike in vivo therapy, which takes the patient into real-world scenarios (which is not practical or even possible with war veterans), VR permits the patient to interact with anxiety-inducing scenarios in the safety and confidentiality of the therapy room. Early results indicate response rates as high as 80% with VR exposure therapy.

In Europe and America, decision makers are beginning to focus attention on technology solutions to this problem. A NATO-supported advanced research workshop, Wounds of War: Addressing Posttraumatic Stress Disorder (PTSD) in Peacekeeping and Combat Troops, organized by the Interactive Media Institute and also supported by the U.S. Army’s Military Operational Medicine Research Program, brought together experts from 14 countries in October 2009 in St. Kanzian, Klopeiner See, Su¨dka¨rnten, Austria.

The American Recovery and Reinvestment Act (ARRA) of 2009 provides the U.S. Department of Veterans Affairs (VA) with $1.4 billion, most of which is to be spent on facilities upgrades, health information technology, and other programs designed to create jobs. The U.S. Department of Defense will receive $7.4 billion under ARRA, most of which will be used in a similar fashion. ARRA requires an unprecedented level of accountability and transparency, so world citizens can track the projects completed with these funds. At this, just one third of ARRA funds have been released.

If one of the aims of ARRA funding is, as DoD states, to ‘‘care for U.S. Service members and their families,’’ surely some of these funds can be directed to large-scale research studies designed to prove the efficacy and cost effectiveness of VR therapy for current and former service members with PTSD. While a growing number of Veterans Administration facilities are using VR therapy in controlled studies that allow veterans to receive this most effective treatment, only when governments consider it a priority to mainstream such therapy can we avoid our ships of state becoming the next Titanic.

Editor-in-Chief Brenda K. Wiederhold