Social Media Wiki

How Pharma Can Cut Out the “Middleman” (aka “The Doctor”)

At some point along the way, I think I swore some oath that I’d use my knowledge for good and not for evil. And yet, I find myself writing posts about (among other things) How to Avoid FDA Regulations Using Mobile Marketing. Granted, I did mention in that post that “I’m not advocating intentionally avoiding FDA regulations,” but I suppose I gave a little help to those who might want to do such a thing (for the record, you rule breakers will love my post about What If There Were No Rules in Pharma Marketing?).

So today I’m here telling you how pharma can cut out the doctor all together. I’m not talking about DTC advertising, I’m talking about a world where pharma makes it unnecessary to go to a doctor’s office as part of the transaction of obtaining a prescription drug. Of course, today you need a doctor to write a prescription for many products. The patient then has to take it to his or her pharmacy to get the medication. That’s quite a hassle. Why not cut out having to go to the doctor? Sure, many Canadian “pharmacies” have made quite a living on this premise using their on-staff “physicians” to do a phone consultation with patients before writing a prescription; a prescription that I’m going to guess is only valid at the pharmacy they work at for many reasons. Naturally, I’m not recommending this approach.

I know that many of you are pretty upset at this idea right now, but bear with me for a moment. You’ll either be much more mad in a moment or intrigued.

Where did I come up with this hair-brained idea in the first place? As a routine, I try to stay on top of new developments in healthcare, especially new uses of digital technologies. A while back, someone called my attention to a company called American Well. I love the concept and what the company is about, but I never really thought of an angle for pharma marketing. Until now…

American Well

American Well’s simple tagline is: “The doctor will see you now.” That about says it all. What American Well does is provide a system that allows patients to talk via live chat, including video, with a physician any time of the day or night. Physicians are recruited by American Well and offered payment to be “on-call” during what might ordinarily  may be an off day. When you log into American Well’s system, you have some choices regarding which physician you’re matched up with. It’s not going to be your regular physician, but it’s going to be quality doctor who is willing to see you right now. They can’t do everything and they likely don’t have your full medical history, so think of it like a walk in clinic. Obviously, you can’t have them stitch up a cut or set a broken arm via the Internet, but for routine care, this is perfect. It could potentially save a trip to the emergency room for many and would be a godsend in the middle of the night for some tired parents.

American Well Interface

For a moment, think about the economics of this for a health insurance plan. Compare what they save on walk in clinic costs and emergency room visits opposite what they pay for American Well’s services. Since health insurance companies are pretty interested in these economic aspects of care, they’re on top of this. If you’re a member of Blue Cross/Blue Shield in either Hawaii or Minnesota, then you’re in luck. Access to American Well’s service is part of your standard coverage. How nice is that? For the rest of us, we’ll have to wait to use American Well. It’s got to be a no-brainer that many other plans will be offering this soon.

But I don’t want to wait and neither should you. However, I don’t have the resources to launch this service for me and all of my readers. Hmmm, I wonder who might though?

Ah yes, pharma companies. Picture this. You log onto, say, the Singulair product website looking for information about seasonal allergies and you’re trying to figure out if this drug is right for you.  After a little research, you decide that you’re going to ask your doctor about it. Now, your allergies are pretty bad, but they’re not killing you, so you try to set up an appointment with your doctor. Two weeks out is the soonest they have available for your non-emergency. Over the two weeks, do you forget about Singulair? Do you even keep your appointment (especially if your allergies got a little better or your schedule forced you to cancel a few times)? Well, if you forget about Singulair or don’t show up for your appointment, Merck is out of a new prescription.

On the other hand, if Merck had licensed American Well’s platform on the Singulair site, then you simply could have clicked a button and spoke with a doctor that second. The doctor would have examined you (as best as possible via webcam), did a thorough history, and asked a few other questions before deciding which allergy medication was right for you. Yes, this doctor won’t know everything about you and they couldn’t do a full hands on physical, but you’re not experiencing chest pains either. The patient, of course, could ask if Singulair is a good option. This physician isn’t a Merck employee and isn’t paid by Merck, so she could pick whatever she thought was appropriate…just like if you went to the office. Managing this kind of condition might be a perfect case where the American Well model works really well. Merck had to pay for the service, but will more than make a return with this new patient now starting treatment.

In the traditional sense, this would be going around the patient’s doctor, but it’s not cutting the doctor out of the equation like a sketchy Canadian “pharmacy.” A qualified, licensed physician made a diagnosis and prescribed a treatment just as he or she does in their “real world” practice. How much different is this than someone going to the Take Care Clinics at Walgreens or similar concepts in many other chains including Walmart? What about stand along “quick care” or walk in clinics? Not much as I see it. In the case of the clinic at Walgreens, you’ll be seeing a PA or NPA in person. In the online version you see an MD (or DO perhaps) via webcam.

Since the physicians on the other end of the service are ordinary doctors looking to supplement their income a bit, they still get the same promotional attention from pharma companies as any other physician in the country. You aren’t likely to find doctors who will only write prescriptions for the company that is sponsoring the use of the service. Even if you could, I doubt that American Well would stand for that and I doubt that any pharma company’s legal team would allow it either. So, what’s wrong with a pharma company providing patients live access to a physician 24/7? Isn’t this an incredibly valuable service to the community? We’re talking an awful lot about healthcare reform right now and about how some people can’t afford to go to the doctor. Well, here’s a pharma company bringing the doctor to you…for FREE.

Am I missing something? Is there any possible way to cast this in a negative light? Perhaps some doctors who aren’t interested in being a part of the American Well program will be a bit upset, as they might lose some patient visits and they’ll claim (probably correctly) that it isn’t the same level of care that they could provide. Fair enough, but is the upside worth the downside? As a pharma company, you can break it down by cold, hard math. Is the value of the increased prescriptions more than the cost of the American Well system plus the loss in prescriptions from doctors who hold a bit of a grudge against the company? Simple math really. Requires some estimation, but not many factors to consider.

So, is this a potentially an amazing example of Marketing with Meaning or a horrible idea that hurts patients and physicians (and “the system”)?

Just to be clear, before you leave angry comments, I’m not suggesting that pharma companies try to cut off the relationship between patients and their doctors. Nor am I suggesting that this be a replacement for an ongoing relationship with a physician who can manage your health over time. Having said that, there are going to be more technologies available that make it easy for people to get the products and services they want using the methods they want. Healthcare is no exception. So, while this might not be the answer or a feasible marketing tactic for pharma, did you know it even existed? If not, what else is out there that you should know about?

What If There Were No Rules in Pharma Marketing?

You’re probably wondering what the image above is all about. Sorry, you’re going to have to read on to get the answer.

Sometimes the biggest inhibitor of the innovation process is ourselves (personal knowledge, expertise, ability, etc.). Sometimes it’s external forces (regulations, guidelines, naysayers). Still other times it’s our interpretation of the external forces. This last one is perhaps the most menacing. Most of us are aware of our own limitations. I’m not about to go out and try to invent a new way to design an airplane wing. I’m not going to try to bring something new to the discussion around a unifying theory of physics. At the same time, most of us know the rules and are forced to live under them. There are these pesky things called laws that always seem to make it all a bit more complicated. Like laws, rules and regulations, such as those from the FDA, often dictate what we can and can’t do. You simply can’t put up a billboard in Times Square proclaiming: “LIPITOR is great for everyone…and whitens your teeth.” Not that you’d do a billboard anyway, but you get the idea. Rules are a good thing in many ways.

However, many times we don’t really know the rules or understand them. Worse still is when we think we know the rules, but really don’t. When this happens, we essentially create a set of “ghost rules” that inhibit our thinking and that of our colleagues. What makes ghost rules especially bad is that they’ve often been around for a long time and no one has ever thought to challenge them. Because these “rules” have often been invented along the way, they are impossible to ever really refute. You can prove that a “ghost” rule is real. Just go look it up. When you see the rule is some FDA guideline, then you’re proved it’s a real rule instead of a “ghost” rule. But how do you prove that a ghost rule isn’t real? If you search for it, you won’t find it anywhere, but because its been around for so long, people might assume that you didn’t look in the right place. It has to be a rule because we’ve assumed it was for so long.

Ghost rules inhibit our thinking and help ensure that we never push to find out what’s possible. You’ve probably been to seminars or had internal training programs about this issue. Maybe you got something out of these sessions and maybe not. For you cynics who didn’t get much out of these sessions, I’m asking for moment that you suspend your skepticism and eye-rolling while I explain why I’m telling you about ghost rules.

Here’s a story that’s been passed around a few times, but the first place I heard it was from David Brennen, the CEO of my former company, AstraZeneca. While I’m not sure his talk was all about ghost rules, his story certainly applied. Here’s the story he told as best as I can remember.

One day a little girl was helping her mother cook Christmas dinner. It was family tradition to prepare the biggest ham they could find along with the many other holiday treats. The little girl watched her mother get the ham ready for the oven and she noticed that just before her mother placed the ham in the oven, she cut the ends off of the ham. The little girl asked her mother why she did that. Did it help the ham cook faster or make it juicier? The mother thought about it for a minute and realized that she didn’t know the answer. The mother’s mother had always done it that way, so she always did it that way. So, to figure out the answer, they called the mother’s mother (i.e., the little girl’s grandmother…stay with me). The little girl asked her grandmother why she cut the ends of the hands. “Simple,” said the grandmother. “When I was growing up, our oven wasn’t big enough to fit the entire ham, so we had to cut off the ends to get it to fit.”

So, do you cut the ends off of the ham and don’t know why? That’s letting ghost rules control the situation. Of course the little girl’s family’s oven could more than accommodate the ham’s size, but they still cut off the ends. It was always done that way, so it continues to be done that way. No one thought to ask why or to understand the purpose. How many rules are you following where this is the case?

Where am I going with this? What’s this got to do with digital marketing in healthcare?

Notice the title of this post again: “What If There Were No Rules in Pharma Marketing?”

I ask you then, “What If There Were No Rules?” There’s no FDA, no DDMAC, no FTC. Your company guidelines and rules don’t exist and your regulatory and legal teams have been disbanded. It’s a free-for-all and there are no rules. The question is: what would you do?

Sounds great, right? But before you answer, keep in mind one very important thing. While there may not be any rules about what you can say, claim about your products, or do in promotion, there’s an unofficial regulatory body that still does exist. People. Patients, doctors, caregivers, researchers, payors, random pharma critics, and commentators/writers (like me). So, you can say whatever you want, but you’re going to be kept in check by all these people. They are the ones who are going to review what you do and decide what’s right and wrong. For those companies that take advantage of this lawless society, the people are going to react negatively. They’ll reject those that make exaggerated claims, those that mislead, and they’ll also reject programs and promotions that just don’t make any sense.

Let’s say you can do anything you want in digital (aka, e-marketing). Would you?

Before you say “yes,” remember a few more things…

  • Even in our lawless, hypothetical world, you still have a budget. All the regulatory people are gone, but there are still plenty of finance people. So, whatever you do still has to fit within your budget and you still have to allocate it across channels.
  • Just because you make it, it doesn’t mean that people are going to use it. Don’t waste your money to build something no one is going to use.
  • People are going to reject and react violently to misleading advertising. Misleading advertising may work in the very short-term, but it’ll kill you over time. Don’t do it just because you now won’t get caught by the Feds.
  • Your competition has the same rules (i.e., no rules). Yes, they came along with you to this magical world.

All right, here’s your big chance. No complaints about how regulated the industry is. No fretting about FDA guidelines (or the lack of them). No excuses about how you can’t do anything innovative in digital in the healthcare industry. So, what’ll it be? What are you going to do first? As a little experiment, please answer the poll below to indicate the tactics you might try and their order of priority. If you want to do something that isn’t listed, then write it in. I’ll write a follow up post to share the answers along with some commentary in the next few days. You can choose up three. (Read on after the poll for more commentary.)

Now, since you already answered the poll, let me guess what you chose. Something social media, probably the community on your brand website. Maybe you picked the Facebook or Twitter page. Alternatively, maybe you chose to “enhance” your messages by showing that data that the FDA won’t allow you to promote. Great. Go crazy. Do whatever you want. There are no rules, right?

I tried to warn all of you who went too crazy. Just because there aren’t any official rules, do you think society is going to let you get away with whatever you want? Sure, you can stretch the claims for your product and get out the data from all those clinical trials the FDA won’t let you promote, but are your target physicians going to fall for it or are you going to make matters worse? Sure, you can create an online community on your brand site, but is anyone really going to join? Do they want to be a part of a pharma company’s community or will they just stick with any one of the many out there already? Same thing goes for your Twitter and Facebook accounts. Do I want to be friends with your pharma brand?

Here’s my point with all of this…the FDA isn’t your problem. But you might have two other problems. First, if you and your company cut the ends off the ham as I mentioned in my story, then you might be the problem. Not exactly you, but the way things are done at your company. The second potential problem is everyone else. You might be allowed to do everything in the world, but is it going to work? That is, will it have a positive impact on your brand?

I guess I’m turning this entire debate about the lack of FDA social media guidelines on its head. Sure, you might like a little guidance, but how much differently would you really do things? Even with no rules whatsoever, you still can’t just do anything you want. There are always unofficial “regulators” and picky, smart consumers who know value when they see it and…well…the opposite when they see that.

Pharma and Healthcare Social Media Wiki Updates (and Badges!)

The updates continue on the Pharma and Healthcare Social Media Wiki. I’ve added about 20 more listings today, which brings the total pretty close to 400 examples of pharma and healthcare social media programs. Thanks to everyone who continues to send recommendations for sites and programs to include in the wiki.

Many of you have asked what you can do to support the wiki, as you’ve found it so useful. Well, there are a few things you can do since you asked:

  • First and foremost, without your contributions, the wiki wouldn’t be what it is today and it would quickly become outdated. You can submit your recommendations for inclusion (including your own site) using this form.
  • Share with your network. Here are some shortcuts:  Send a tweet, update your LinkedIn or Facebook status, and/or whatever your preferred means of sharing is. You can just copy and paste this: “Pharma and Healthcare Social Media Wiki. http://su.pr/20M8CB. (via @jonmrich)”
  • Write about it. Feel free to blog about the wiki and use some of the examples in case studies or presentations you’re developing.
  • Get a badge. That’s right, if you’re listed on the wiki, you can now add a badge to your site to show that you’ve made it to the list. We’ve created a couple of options to choose from.

<strong>Note:</strong> some of you who have tried to use the code told me that it wasn’t working for you. I’ve fixed the problem, so these should work fine now.

Option 1

Dose of Digital Pharma and Social Media Wiki Badge v1

Copy and paste the code below onto your site:

<form><a href="http://www.doseofdigital.com/healthcare-pharma-social-media-wiki/" target="_blank"><img src="http://www.doseofdigital.com/wp-content/uploads/2009/08/doseofdigitalwikibadge1.jpg"/></a></form>

Option 2

Dose of Digital Pharma and Social Media Wiki Badge v2

Copy and paste the code below onto your site:

<form><a href="http://www.doseofdigital.com/healthcare-pharma-social-media-wiki/" target="_blank"><img src="http://www.doseofdigital.com/wp-content/uploads/2009/08/doseofdigitalwikibadge2.jpg"/></a></form>

Again, thank you all for your contributions. If you have any suggestions on how to improve the wiki, please let me know. We’ll be undertaking a big design and organization project some time soon, so feel free to weigh in now.

6 Steps to Getting Your Healthcare Social Media Idea Approved

Dose of Digital Mini White Paper

Ready for this revelation? The healthcare industry, particularly pharma, is heavily regulated. I know, a shock to all of you. You also probably have heard that every company in this industry has a team of lawyers and regulatory folks whose sole responsibility is to ensure that the company isn’t getting into trouble with regulators. Many of these internal folks are charged specifically with making sure marketing teams aren’t putting the company at risk with a program that violates regulations. As a former pharma marketer, I know these folks have prevented me from getting into what likely would have been some pretty hot water over the years. That’s what they do. However, in some cases, marketers view these internal groups as another obstacle to getting their program into the market. I’m sure that at some companies this is truly the case. I don’t have a lot of advice for you if this is your situation.

For those with more enlightened teams who are willing to work closely together, I’ve got some advice that I think can make it even simpler. I mentioned in my talk at the Business Development Institute that, to borrow a term,  “it takes a village” to get a program approved, particularly if that program is social media based. Never before has a single healthcare marketer conceived, developed, and launched a program on his or her own. There are teams of people that help along the way and some of these people are charged with making sure  that the program isn’t going to get the company in trouble. So, if it does “take a village,” how can you get your village on your side?

Here are what I think are the most important things you can do as a marketer give your program the best chance of approval:

  • Know the “why”
  • Become your own toughest critic
  • Check in along the way
  • Be an educator first
  • Force “Yes, if…” instead of “No, because…”
  • Try something

Know the “why”

The regulatory folks at your company aren’t standing in the way of your program because they don’t like you (probably not anyway). They aren’t saying “no” because it’s much simpler to do so. They have good reasons. Likely, they understand both the internal and external rules much better than you do. As you’re developing your program, invest some time in understanding the regulatory rules that are likely to have an impact on your program. If you do this well, then the approval process should be much simpler and it’s going to allow you to be a better partner, as you’ll be able to really understand where your regulatory colleagues’ concerns.

Become your own toughest critic

Be honest. You know the flaws in the program you’re creating. You know why it will never get approved as is. Why bash your head against the wall then? Be tough on your program just as you know your regulatory team will be. Doing this during the development process is going to force you to rethink things and to look for ways to do them differently. This might be where the big breakthrough comes from. A word of caution: don’t completely stifle an idea because you think it’ll never get approved. That’s an innovation killer. Figure out a different approach that might work or…

Check in along the way

You probably have a very formal process for reviewing a new program. That’s good. But sometimes, you need to go outside this process a bit. As you’re developing your program and run into something that you think is going to give your regulatory team (and therefore federal regulators) heartburn, ask. Ask someone on your regulatory team for advice. You can do this rather informally and it may save you a ton of heartbreak and money later on. It makes no sense to completely develop a program (including all the resources you’ll use) only to find out that the key component is a complete non-starter. Check in before you commit too much to see where the problems might lie. You can not only do this internally, but also externally as well. You can request a meeting with DDMAC (the pharma marketing arm of FDA), for example, to review an idea before it’s complete. They will give you their take on why or why not your program is all right. This is a formal process that your regulatory team can help you set up. If you’re thinking about a really big, really innovative program, don’t get a million dollars into it before you figure out that DDMAC will never allow it. Take advantage of these meetings. Your fees and tax dollars are paying for them anyway.

Be an educator first

You may be a social media expert. Great. Chances are that the people who have to approve your program aren’t. That’s a problem. While you’ve invested a lot of time figuring out how to, say, do a brand page on Facebook that will be compliant, your regulatory teams might not understand the finer points of Facebook. Because of this, they only can go on what they’ve heard or read. We all know that’s not enough. You never really understand the finer points of a channel until you dig in yourself. That’s part of your job. While you can argue that it’s also part of your regulatory team’s job too, it might not be happening that way. That’s where you come in. Educate your team. Teach them about emerging channels and the benefits and risks of each ahead of time. Don’t try to teach them about Twitter in the meeting where you’re asking for approval to do a branded Twitter page. It’s a little late then. (My company, Bridge Worldwide, via WPP, offers a “Digital Immersion” program that can do this sort of training as a one-day seminar. Contact me if you’re interested in hearing more.)

Force “Yes, if…” instead of “No, because…”

This one isn’t mine, but I had to use it because it says it all so perfectly. It comes from Marc Monseau, Director, Media Relations at Johnson & Johnson. You may have heard his name from the J&J blog he helps edit or the J&J Twitter account that he manages. Both, in my opinion, are the standard in healthcare. Marc sent this tweet a couple weeks ago in connection with the Business Development Institute (#BDI) conference I mentioned earlier:

jnjcommtweet1

Think about that for a minute. Which do you hear when you propose something to your regulatory group? The first one, “Yes, if…”, indicates someone who’s willing to help you find a way to make your idea possible. You might not like the concession, but it’s a step forward. The latter, “No, because…”, tells me that this regulatory person isn’t interested in a solution, but rather just in following the company’s and federal regulatory rules. It doesn’t have to be that way though. Force your regulatory teams to think about the issue with “Yes, if…” instead of “No, because…” It’s a powerful difference. You can enable this by talking this way yourself during the discussions with your regulatory team. Come prepared with alternatives and be willing to compromise (assuming it doesn’t kill the intent of your program), but also encourage your colleagues to do the same. PS: you might want to add that this idea comes from J&J, who probably has the most robust social media program of any healthcare company.

Try something

This isn’t “Do something just for the sake of doing it.” Here, I want you to try something because I want you to test all of the above. If your company hasn’t delved into any major social media initiatives and you suddenly spring one on them, expect it to be denied pretty quickly. Instead, do something small now. Maybe an unbranded Facebook page. It doesn’t have to be incredibly robust and the point isn’t to get thousands of people to join. Your goal is to test your process. The process for approving a social media program might be completely different than any other program. Do you know the process? Is there a process? Maybe you need approval from a higher level or the PR/corporate communications team needs a say. The process may be totally different from everything else. Figure it out now, so that when your big program comes up for review, people will be familiar with the process and you won’t have to waste time figuring it out. Also, if you need to respond very quickly to something in the social media space, you can’t waste time creating a process, as things happen in hours, not weeks when it comes to social media.

These six steps are designed to help you and your company advance its social media program. In the end, you’ll need a lot of people to buy into it, so make it as simple as possible. Like many things in life, getting a major program (that also relies on a newer channel) approved involves some selling. These tips hopefully make your sales call just a bit easier.

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