I also like being “in the know” and there’s typically some backstory to the meme that you need to understand for it to make sense. It’s kind of like an exclusive club for the Internet set of us out there.

What I really like about memes is how you can use them to express a really simple concept.

For those of you who don’t really know what a meme is, here’s the official definition (thanks to Google’s handy “define” feature):

An element of a culture or system of behavior that may be considered to be passed from one individual to another by nongenetic means, esp. imitation

So, the key feature of a meme is really it’s ability to be passed along from one person to another. Sometimes it’s a joke and sometimes it’s a movement and something far more serious. However, when I look at a meme, I do something different than most people. I try to look for a lesson. I look for the one thing that I can learn from it. I also look at memes and figure out how I can use them to explain something else and to try to better understand human nature.

I’m weird like that.

This is what I’m doing today. I’m going to use the top memes of 2011 to review everything I witnessed as far as digital marketing trends in 2011. There will be plenty of lessons mixed in along the way. Chances are that you haven’t seen or heard of all of these memes (maybe none of them). You might not get some of the jokes, but I’ll do my best to explain them and I’ll point you to the good folks at Know Your Meme to give you even more detail if you want it.

The list of the top 10 memes for 2011 comes from Know Your Meme. They just announced the “winners” based on a survey of its users. The nominees were drawn from the most discussed and mentioned memes of the year. I’ll review them (and tie them to a little lesson about digital marketing) in no particular order (though I saved my personal favorite for last).

Before doing that, you might want to watch Know Your Meme’s 3 minute review and explanation of the “winners”. That might help some of you for a little background on these memes, as some defy simple explanations. I did include a little, written explanation of each meme as well.

So, without further delay…let’s jump right in:

1. “Nope! Chuck Testa.”

Quick explanation:

Nope! Chuck Testa is a catchphrase coined by Californian taxidermist Chuck Testa and filmmakers Rhett and Link. The one-liner became immensely popular after the ad made for his business received massive attention through social news sites like Reddit in mid-September. The commercial features several family members of Testa being fooled into thinking taxidermied animals were alive before being told by the man himself who proclaims “Nope! Chuck Testa.” (source)

For those of you who are a little uneasy about taxidermied (is that a word?) animals, this isn’t going to be a big hit with you. Here’s the commercial created by taxidermist Chuck Testa that started it all:

This video was shared all over the place after appearing on Reddit in September.

The Lesson:

So, what does this have to do with digital marketing? Not a ton except for one line from the commercial:

“I specialize in the most lifelike, dead animals anywhere.”

Chances are that the content you’re creating for all of your digital marketing efforts including what you distribute via social media could best be described by this line. You are doing what you think makes sense to add a little sizzle. You’re trying to make your brand or company seem way more interesting than it really is by following some formula you’ve read about. That is, you’re taking marketing that’s dead and trying to make it lifelike. In the end, you’re really just pretending. This might fool some people from afar, but when they get up close, they’re not happy with what they find.

If you want to make content that isn’t dead, you probably have to do things a bit different. Yes, this means actually investing in content development. It means hiring someone who knows how to produce quality video content (and not necessarily James Cameron). It means that you have to go beyond your “core messages” and tell other stories that people might actually find compelling. Until then, you’re just making content that’s lifeLIKE and not actually alive. Big difference.

There was way too much lackluster content out there in 2011 (and in every year before that) coming from companies. 2012 ought to be the year you vow to change that for your brand.

2. Planking

Quick explanation:

Planking, often referred to as the “planking craze”, refers to the act of lying face down with arms to the sides in unusual public spaces and photographing it to share online. (source)

Rather than describe planking in more detail than this, this is a case where a picture is worth a thousand words:

You’re probably asking “Why?” right now. I don’t know. It’s just one of those things that people do. Sometimes human behavior doesn’t make that much sense.

The Lesson:

But there is a lesson in here for us and it’s a trend in digital marketing that I’ve noticed. There are a lot of hot fads that come and go. Some last for years and others for days. Brands that capitalize on them quickly can be very successful. However, there’s one thing for certain about these fads. They will all disappear. So, while you’re busy planning how to take advantage of one, know that you’re probably too late. You need to be able to react instantly if you plan on playing in the fad arena. You don’t want to be the brand who is talking about planking now any more than you want to be the brand showing off the new branded vuvuzelas you just made (how about that for a 2010 throwback?).

Be prepared to act instantly and not after 3 weeks of legal reviews if you want to capitalize on what’s hot. The other lesson in here is that capitalizing on what’s hot doesn’t always make sense for every brand. Use your head.

3. Occupy Wall Street

Quick explanation:

Occupy Wall Street is an ongoing series of protests in New York City and elsewhere across North America and Europe that seek to resolve socioeconomic inequality and curb the influence of corporate lobbying on Washington politics. Mostly coordinated via social networking services like Twitter and Facebook without a central organizer, the flash-mob demonstration began on September 17th, 2011 and the spirit of protests have since spread across dozens of cities and campus areas in the United States. (source)

You probably have been living under a rock if you haven’t heard about the “Occupy” movement. Usually a cultural movement like this wouldn’t really qualify as a meme, but based on the way it really spread via social media at first probably qualifies it as a meme.

The Lesson:

The lesson here is really simple. More and more brands are embracing social media and using it as one of their key marketing tactics. It pretty much became accepted, standard practice in 2011. However, at the same time, many brands still aren’t doing it right. They refuse to accept the notion that you can’t completely control what happens to your brand once you open yourself up to the world of social media. People aren’t going to do things exactly the way you want. They are going to want to ask questions that make your legal team uncomfortable. They are going to protest when you mess up. They are going to expect that you listen to them. You know…just like real life.

There were plenty of social media screw ups in 2011 (find a bunch of them here) and you probably nervously laughed at the poor companies that tried to recover from mistakes while you secretly hoped that you’d never find yourself in the same position. Knowing that you can’t always be completely in control and having a plan to deal with the unexpected is critical. You never know when a movement like Occupy is going to show up at your front door. You just have to be ready to handle it. I’m still amazed how many companies that use social media regularly aren’t prepared for controversy. Head into 2012 with something different.

4. First World Problems

Quick explanation:

The frustrations of privileged citizens around the world has been a consistently trending topic on Twitter with#FirstWorldProblems, a hashtag used to make light of minor inconveniences that people of advanced societies often complain about, like having too many tabs open or still being hungry after brushing teeth. (source)

Here’s a great example:

The Lesson:

Yep…we’ve all got problems. That includes marketers. However, many of the problems marketers profess about the challenges of selling their brands out in the world come off to many people about as serious at First World Problems. To put it another way, people don’t care about the regulations or your company rules that make it hard for you to, for example, answer their questions on Twitter or cause you to take a month to respond to their email. People don’t want to hear your excuses. They want results.

To compound your troubles, people see other brands in other industries doing innovative things and they wonder why you won’t do the same thing. For example, Starbucks has My Starbucks Idea and solicits ideas to improve people’s experience with their morning coffee. What people then think is this: “If the company that makes my coffee is listening to me and implementing ideas to improve its product, how come the company that makes my HIV drug doesn’t do the same?” Point is, one is much more important than the other and yet you don’t see the latter. You can apply this to many situations and different industries. The takeaway message is that if people see one brand do it, then it becomes an expectation that you do it as well.

Your task for 2012 is to stop complaining and giving excuses and figure out how to do the things that your customers expect you to do.

5. Nyan Cat

Quick explanation:

Nyan Cat is an 8-bit animation depicting a cat with the body of a cherry pop tart flying through outer space. While dada-influenced images like Cat on a Keyboard in Space and Cat Bread have been around for some time, this particular combination of Pop Tart Cat and the Japanese Vocaloid song Nyanyanyanyanyanyanya! has captivated YouTubers and online art communities, spawning dozens of fan illustrations, video remixes and even musical tributes.(source)

Got it?

I’ve got to admit that this one really confounds me as well. You really need to see it in action to “appreciate” it. A bit of warning, after about 10 seconds of this video you’ll either start smiling and laughing or you’ll smash the device you’re watching it on just to stop the noise. Turn up your speakers now.

There you have it. Nyan Cat. I probably should have closed with this one.

The Lesson:

The lesson here is very simple and one that I wish more marketers would learn. Unfortunately, 2011 helped to ensure that this lesson will continue to be ignored by many marketers for the foreseeable future. 2011 brought us viral videos sensations from brands that included the “Darth Vader Volkswagon” commercial, “Doug, Ford’s Sockpuppet”, and the epically annoying (IMHO) “Kia Hamsters”.

When marketers see these along with hearing about the Old Spice Guy for yet another year, they think they can do the same. So, what happens? They go into a room and hatch a plan to create a “viral video.”

I’ll say it again, though I’ve said it about a million times before, you don’t create a “viral video,” if you’re exceptionally lucky your video could become a “viral video.” You don’t decide if it “goes viral,” we do. That’s right…we the people. If we don’t like it and find it shareable, then it’s not going to be a viral video. Sure, you can dump millions into paid media to promote your video and millions more to air it during the Superbowl, but that’s cheating just a bit. You paid for all those impressions. A true viral video is spread on its own just like Nyan Cat. It’s spread because people want to share it with others.

Please resolve that 2011 was the last year you’ll write down “create viral video” as a marketing tactic. Create video content for sure, but don’t expect it to be viral. Make it really good, seed it in the right places, and hope for the best.

6. 60s Spider Man

Quick explanation:

60’s Spider-Man is an image macro series based on still shots from the original Spider-Man cartoon series, typically featuring an absurd internal monologue that correspond with the actions depicted in the images. (source)

Once again, it’s hard to explain why the Internet does what it does. A picture might help a bit.

You’ve got to admit that this is a little funny.

The Lesson:

What makes the 60s Spider-Man memes amusing is the fact that they are typically depict an awkward situation and the intent of the original illustrators doesn’t remotely match what people have added on their own (here are a bunch more).

This is what a lot your digital marketing is like.

It’s a bit awkward. It might not fit exactly what makes sense for your brand and it confuses people. This is especially true when you factor in your social media efforts. The main reason for this is because many marketers don’t take the time to really integrate their digital marketing efforts with all of their other marketing. Again, this comes out with social media, as teams create a “social media strategy” completely in a vacuum while they forget all about the actual brand strategy.

What ends up happening is that you have a brand with multiple personalities disorder. Your brand has a happy-go-lucky, irreverent tone in social media, but a stern and serious personality in your TV commercials. Or your brand is known for fun, but your videos put people to sleep.

It’s all got to match to make sense to people. Your brand needs to have one personality and one voice. Your efforts across all the different marketing channels need to work together. This may mean getting together people that don’t normally review their plans together, but it’s essential to avoid what poor Spidey has to endure. Start out 2012 by really understanding how your brand is represented in every one of your marketing efforts and make it uniform.

7. Rebecca Black

Quick explanation:

The Californian teenage girl Rebecca Black‘s rise to national fame with her autotuned pop single “Friday” was a moment of realization for many aspiring singers and producers: you don’t necessarily have to be the best at what you do to be famous. Originally uploaded in early February, the video began receiving massive exposure on hubsites like YouTube, Twitter and Tumblr after coverage by The Daily What on March 11th, 2011. Within a week, the video gained over 10 million views and the digital single entered the top 100 on iTunes. (source)

This very well might be one of the biggest viral videos of 2011. If the Nyan Cat video didn’t make you laugh or smash something, this will. Ladies and gentlemen, I give you “Friday” from Rebecca Black:

Bob Dyan she ain’t. But that’s okay, we can still learn something.

The Lesson:

This one is going to be hard for many marketers to understand. That’s okay, it’s hard for everyone to understand. Here’s the lesson:

Sometimes bad is actually good.

I think we can all agree that this song is awful. As the top YouTube comment on this video summed up: “This song kills babies in Africa.”

A bit harsh to be sure, but how does Rebecca take all the criticism?

To the bank.

That’s right. By now, she’s basically accepted the criticism and just goes with it (or ignores it). It turns out that it doesn’t matter if people really love your music or think you’re Mozart, it matters if they buy your records. And people did buy Rebecca’s song and made it a top 100 song on iTunes. That’s a lot of 99 cent purchases. The lesson for you, Mr. and Mrs. Marketer is simple: don’t take yourself so damn seriously. If people come to brand because they want to see more of a video you made that they find horrible, don’t immediately pull the plug on your site and take down the video. Figure out if you can, well, turn lemons into lemonade. Have a little sense of humor and people will respond to that. If it moves cases of your product and doesn’t do permanent damage to your brand, then you probably should just go with it.

Lighten up in 2012.

8. My Little Pony: Friendship is Magic

Quick explanation:

The epidemic sensation of My Little Pony in 2011 has been both formidable and persistent. Developed by the Powerpuff Girls illustrator Lauren Faust, the largely for-girls show has become an omnipresent fixture in the internet culture, triggering an epic internet fight between pro-bronies and anti-bronies, not to mention the moderates who think ponies are appropriate for only certain situations. Since its on-air debut in October 2010, the series became a popular source material for threadjacking, reaction images, and macro images on 4chan, YouTube and elsewhere online. (source)

On the surface, this meme seems to defy explanation…

Okay, it’s not just on the surface. No logical explanation can make sense of this.

The Lesson:

And, that’s the lesson. Human’s are, for the most part, completely unpredictable. We do our best to predict what a certain person or group of people (our “target audience”) will do or how they will react and we’re usually wrong. On top of this, we are really good at making excuses for why we were wrong, so we quickly forget that we aren’t really good at predicting the future or human behavior. It’s selective memory at its finest.

Yet we’ve built an entire industry around trying to predict human behavior. We call it “research.” We conduct focus groups and commission surveys. We pour over “behavioral trends” and create “personas.” All of this is designed to do one thing: predict the future behavior of a group of people. However, it’s always a group of people that we really can’t understand, that’s still very heterogeneous despite our attempts to lump them together, and that have far less in common than not in common.

And while we might be able to predict how one person might behave, we often fall down when there starts to be more factors. That is, we usually can understand one person, but we can’t ever hope to understand the millions of different interactions experienced by that person in a given day that impact his behavior. We can’t predict the interactions between people. That means we can’t hope to really predict the behavior of a large group. The reason for this is simple. We can’t understand every possible motivation of every individual in the group. We may understand a few motivations of a few people (or even all the people), but we don’t know them all. More importantly, we don’t know which motivations will actually impact their behavior.

When two groups that to all of our research techniques appear identical behave differently from one another, we try to explain this by providing group-level explanations. We might argue that we didn’t realize that one group was richer than the other or less educated or something else. In reality, these are convenient explanations, but probably aren’t right. The two groups could be exactly identical in every way except for one different person in one group. That one person could be one person in a thousand, so it would be impossible to observe him in the crowd. But if that person wanted to incite one group to riot, he might be able to do it. If that same person isn’t in the second group, there’s no riot. Our research would try to explain this after the fact by looking at macro factors when the real explanation is the presence or absence of one person. (For more about this, read up on Granovetter’s Riot Model [PDF]. Also, get the book Everything is Obvious: *Once You Know the Answer, which talks about this concept and our inability to predict the future and explain away our mistakes.)

Okay, so what does that have to do with My Little Pony?

Everything.

There was no way to predict precisely who this show would appeal to. It was designed and marketed to young girls and yet it found a place with a huge and disperate set of people. How’d this happen and why didn’t “research” predict it? It happened because a few people wanted it to happen. These were people who you couldn’t have identified in research. Their behavior and interactions with others couldn’t be quantified and yet they were the key factor in explaining this phenomenon. Remember that predicting behavior and being able explain why the behavior happened after the fact are very different things. A great quote from Everything is Obvious explains this well: “…our impressive ability to make sense of behavior that we have observed does not imply a corresponding ability to predict it…”

So, when you’re conducting research in 2012, be realistic about what is possible to know. Expect to be wrong. This is okay. Don’t use this an excuse not to do good research. I’m not saying that. Research is stil critical, but be realistic about what it can tell you. To ensure that your plans and product aren’t a failure, you need to recognize the limitations of your research and plan differently. You need to create marketing plans that are flexible and can quickly be adjusted as new information comes in. Take this new information and construct a new hypothesis and then act on this. If your plans are completely inflexible, they have a much higher chance of failing or at least missing big opportunities. Will 2012 be the year of your own “My Little Pony” and will you be ready for it?

9. Scumbag Steve

Quick explanation:

Scumbag Steve is an image macro series featuring a young man with a sideways fitted cap standing in a hallway. As the name suggests, the joke illustrates a wide array of “d-bag” stereotypes from high school and college years, like that guy who borrows your lighter and never returns it. (source)

And the image…

The Lesson:

Okay marketers, this one’s going to hurt, so get ready.

You’re all Scumbag Steve.

All right, not ALL of you, but many of you. I’ve created my own version of the meme to describe the problem:

That’s right. You make these hugely elaborate websites with flashy (literally and figuratively) designs and videos playing and all sort of other bells and whistles. Then you add in a million of your “core messages” and soon enough you’ve created a site that looks great, but is impossible to navigate. It might make sense to you and that’s because you worked on it since day one, but it doesn’t make sense to everyone else and that’s all that matters.

Or you create a great looking site that has a search box, but it doesn’t actually work. It doesn’t actually search the content of your site because you didn’t build it right (the search function or the site). That annoys the hell out of people. Or maybe you have a great looking site with a ton of broken links that lead to uninformative 404 error pages. There’s no reason you should have any broken links on your site. Spend a little less on adding one more flashy element and index your content the right way first. It’s not sexy, but it’s what people need.

There’s a little analytics stat that you can track to measure some of this. It’s perhaps the most misunderstood and, in my opinion, wildly overrated measurement of website performance: time on site. I’ve read goals for major sites from huge brands that have the stated objective of improving “time on site” or increasing it to X number of minutes. Well, here’s some news for you: increasing time on site might not be a good thing. If I come to your site looking for one piece of information, but your site is so poorly organized and difficult to navigate that it takes me 10 minutes to find the answer, don’t pat yourself on the back. Sure, your time on site is really high, but so is your customers’ blood pressure. The reverse is true too. If you make a site that enables people to quickly find what they need and then get on with their lives, your time on site might be really low. That’s not necessarily a bad thing.

So, bottom line, fix your site so that it’s easy for people to use. Concentrate on user experience before you worry about design. It’s got to work and make sense for people to navigate first before you make it look great. That’s your mission in 2012…and fix your broken links.

10. X All the Y!

Quick explanation:

“X all the Y” is a snowclone and exploitable cartoon used to make a hyperbolic statement about performing an action. First published in the comic “This is Why I’ll Never be an Adult” (shown above) by illustrator Allie Brosh, she apparently sought to convey frustration with her inability to maintain a consistent enthusiasm for her daily responsibilities. (source)

Here’s the original version of this meme:

I love this one. It allows for so many different uses. People have created thousands of these to reflect all sorts of exaggerated expressions about certain topics.

The Lesson:

I’ve actually created two of these just for the purposes of this lesson. Can you tell what the theme of the lesson is?

And this one…

Figure out the lesson yet?

There was a lot of enthusiasm this year around two things: building mobile apps and putting QR codes on EVERYTHING.

Let’s deal with the mobile apps thing first. If you want to build an app (and chances are you’re only talking about making an iPhone app), that’s fine. But, before you do that, how about taking care of some other things first? Item number one, since we’re talking about mobile, build a mobile version of your website. Forget about making an app, make a mobile site first. That’ll be used far more often by people than your app (more on that in a minute). Building a mobile site might not be the sexy thing to do, but it’s the most practical one that will actually be a benefit to people. And it doesn’t need to cost a fortune either. There are plenty of companies and services that can get you up and running fast with a quality mobile (and tablet) marketing platform. While I’m at this rant, make sure you add a link to the mobile version that lets me view the full version if I so desire. There’s nothing that frustrates me more than being automatically redirected to a mobile site, finding out that I can’t access the info I need, and then not being able to get back to the full version. Don’t do that.

So, you’ve got a mobile site already, eh? Congratulations. Now you want to build an app for your brand. Chances are you this app to prominently feature your brand. That’ll likely guarantee that people won’t download it or use it. People don’t want an app that amounts to a non-stop commercial for your brand. Okay, maybe your app isn’t a commercial. That’s great. However, it does the same thing that a million other apps that people already use do. Again, you’ve just wasted your money. Don’t go down the path of creating an app unless you’re going to create something unique that people really want. That’s hard for many brands to do and won’t work for many. That’s okay. Spend your money elsewhere, there’s plenty of other opportunities out there.

And QR Codes.

It seems like everyone wants to put a QR code on everything. You’ll even put them on billboards. Yes, billboards…alongside a highway. I’m not sure I could devise a more dangerous premise for a billboard than asking someone to slow down in their car, take out their phone, open the QR code reader app,  line up and focus the camera, and snap a picture all while not crashing. Perhaps a billboard that shot high power lasers directly into drivers’ eyes in an attempt to burn the URLs onto drivers’ retinas would be slightly  more dangerous. Here’s a great post from my colleague Bob Gilbreath on this disturbing trend (including photographic evidence in case you don’t think any marketer would be this foolish).

QR codes aren’t the saving grace or marketing holy grail that they have been billed as by some people. It’s a transitional technology that will soon disappear as NFC (near field communications) become more widespread. For all the reasons outlined in this great BI post, I agree that QR Codes are (or should) be on their way out. Here’s a relevant snippet from their post about why these things are terrible:

“Most people, before scanning their first barcode, have to download scanning apps manually and figure out how to use them. Then, each time there’s a barcode to scan, they have to make sure they’re using the right scanning app for the right barcode. That’s because different types of barcodes, like Microsoft’s “Tag” codes, don’t always work in all the same apps. And then there are the inevitable delays in finding the barcode app in your phone, waiting for the camera to prepare itself to shoot photos, getting the right distance and focus on the barcode, and hoping the mobile data network responds to your query quickly enough to be worthwhile.”

Only a tiny minority of people (5%) have ever used a QR code according to Forrester. To put it another way, 95% of people who look at your QR code have no idea or no interest in doing anything with it besides wonder why marketers keep sticking them on things.

Again, don’t expect QR codes to perform some sort of magic for you. If for some reason you still feel compelled to use one, then have it do something that makes sense. My “favorite” is when a QR code points to a website that is made entirely out of Flash and isn’t mobile-ready. I can’t see a thing on my iPhone and you look ridiculous. Also, don’t put QR codes in places like subways where there is no mobile service. I need to be able to access the Internet for your QR code to work. And yet, I find myself on the New York subway and every ad has a QR code on it and I have zero bars of service. Common sense, people.

So, for 2012, use your head and don’t get overly excited about anyone technology or trend. This includes mobile apps and QR codes. I’d also appreciate if you stopped putting QR codes on billboards. My drive home is already dicey enough without the added risk of drivers attempting to actually use these codes.

And there you have it. The year in memes for 2011 all tied to some important lessons for digital marketers.

Did I miss any meme that you think would teach a valuable lesson? Feel free to add it to the comments.

Somewhere along the way, I began to notice that I developed a really low tolerance for the abuse of legitimate research and statistics in an effort to garner a great headline. When I see these headlines, I’m usually among the first to dig into the “research” and figure out the real story. What’s missing? What methods were used? Do the actual conclusions match the headlines? A favorite of mine is the chart at the top of this post (courtesy of the P.A.P. Blog). Not every headline purported to be backed by statistics makes sense even if it appears to on the surface. This one appears to show that increasing the number of lemons imported to the US from Mexico reduces highway fatalities.

Healthcare social media is a pretty hot topic of course, so getting anything out about this topic is sure to get some attention. This fact makes me even more suspect when I see a headline pop up about some new research finding that’s published in major media outlets. Of course, where I see these things come up first is on Twitter where there’s an echo chamber effect of people sharing the same story back and forth and with hashtags that make it simple to follow along. (Pro Tip: stay tuned to the end of this post for a sneak preview of some unpublished Pew Research data about healthcare social media use).

One research study that came up recently and I still see from time to time pop up came from the National Research Corporation. They released the results of a survey via press release with the enticing title: “1 in 5 Americans Use Social Media for Health Care Information.” Here are the first two paragraphs of the press release:

“LINCOLN, Neb. – February 28, 2011 – One in five Americans use social media websites as a source of health care information, according to National Research Corp.’s Ticker survey, the largest, most up-to-date poll on consumer health care opinions and behaviors.

Facebook topped the list of available websites, with 94 percent of respondents indicating they’ve used the popular social network to gather information on their health care. 32 percent used YouTube, a video sharing site. Twitter, an emerging micro-blog site for B2C communication, landed in third with only 18 percent of respondents – tying with MySpace. FourSquare, a location-based website, garnered only 2 percent response.”

I have a lot of problems with this bit of research and I’m going to outline them not to attack this particular study, but as a lesson to everyone about how to these things the right way and what I believe is the wrong way. There are several issues that I see over and over again with data like this, so I’ll list these here, so that you are a bit more alert to potential problems with the research you come across each day.

• Issue 1: “Rounding Up”: The headline of this release is “one in five Americans”, but the actual number from their data is 15.8%. One in five is 20% and makes for a nice round number and sounds much better than “one in 6.25 Americans” or “4 in 25 Americans” (if you don’t like quarter people). For those who don’t like to do the math, “1 in 5″ is 25% higher than “1 in 6.25,” which is pretty significant.

• Issue 2: “Transparency of Data”: You’re probably asking, “how is it that Jonathan that you know the actual number and I don’t?” Well, I asked the company for the actual results so I could review them for myself and they sent me this spreadsheet. That’s the only place you can find the real numbers. Without it, you’d have to get all your information from a press release. This is issue number two for me. If you know that you’re releasing a somewhat provocative piece of data, why not show the full information? Why only make a press release available? If you do this, you shouldn’t expect anyone with even a slight academic bent to place any confidence in the results.

• Issue 3: “Proper Context”: Paragraph (actually sentence) number one of the release gives us the one in five number and mentions how big the survey was. Paragraph two leads with: “Facebook topped the list of available websites, with 94 percent of respondents indicating they’ve used the popular social network to gather information on their health care.” What’s missing here is a very important qualifier, which if included would make the sentence read like this (I added the bold): “Facebook topped the list of available websites, with 94 percent of respondents who said they use social media as a source of healthcare information indicating they’ve used the popular social network to gather information on their health care.” There’s a big difference between these two sentences. One seems to imply that 94% of Americans use Facebook as a source of healthcare information. The other implies that 94% of the 1 in 5 people who use social media as a source of healthcare information select Facebook as their top source. So, that’s actually not 94% of people, but rather 18.8% of Americans (94% of 20%) and, as we’ve already seen, this should be 14.8% of Americans indicated Facebook was their top source since the real number isn’t 20% but 15.8%.

The problem with reporting data like this is that people quickly take bits out of context. This really isn’t National Research’s fault, but I think being very explicit about sound bites of data is critical when you release them so as to minimize any chance of pieces being taken out of context.

• Issue 4: “Mixing Data and Opinion”: Researchers are expected to provide some interpretation of the their data when they report it. It’s the “Discussion” section of any good research write up. However, a critical point here is that what was found in the study and what is interpretation of data need to be clearly separated: objective versus subjective. That is, I need to know when something was stated by respondents and something is the opinion of the author. Case in point from the National Research press release: “Americans think highly of the usability of social media but are tempered in crowning it the premiere source of health care information when considering all options.” This is “supported” by two other pieces of data from the survey:

“When asked social media’s influence, 1 in 4 respondents said it was “very likely” or “likely” to impact their future health care decisions.”‘

“When asked their level of trust in social media, 32 percent said “very high” or “high”, only 7.5 percent said “very low”.”

I’m not sure how these two bits of data support either “Americans think highly of the usability of social media” or “crowning it the premiere source of health care information when considering all options.” What the statement seems to imply is that, first, Americans think highly of the usability of social media (i.e., it’s easy to use) and, second, that they are in some way are considering it as a potential substitute to other sources of healthcare information. This would be fine except for the fact that there are no survey questions related to either point. Again, how do I know this and you don’t? I asked for the survey questions (see Issue 2 again), which you can find here. There are no questions about the “usability” of social media nor any questions about how social media sources rank against any other sources when it comes to healthcare. I don’t mind if someone makes this leap, but temper it with a clear statement indicating that it’s opinion instead of implying that it comes from the actual results.

• Issue 5: “Definitions”: One of my biggest issues with particular study is the use of the term “healthcare information,” as in “One in five Americans use social media websites as a source of health care information.” What does this mean? This could range from anything from doing in-depth, fact-based, serious research on a medical condition to mentioning in a status update that you hit your funny bone. When you leave it up to respondents to define a term like this (as National Research did), expect people to interpret what this means in their own way. They asked: “Do you use social media (e.g. Facebook, Twitter, MySpace) as a source of healthcare information?” My response would be: “It depends on what you mean by healthcare information,” but that wasn’t an option. This is a critical point because not only do respondents interpret what this means, but so do those reading the results. Again, one person reads “as a source of healthcare information” as serious research and another reads it as throwaway comments on a friend’s funny update.

• Issue 6: “Getting the Details Right”: I first found out about National Research’s survey when I read about it on CNN’s “The Chart” blog. It’s a pretty reliable source of good information and is written by people that I respect. However, they got this story wrong. CNN reported this in their review of the survey: “In the survey of nearly 23,000 people in the United States, 41% said they use social media as a source of health care information. For nearly all of them – 94% – Facebook was their site of choice, with YouTube coming in a distant second at 32% [emphasis added].” The problem is that 41% isn’t the actual number. As we’ve already seen, the actual number is 15.8% use social media as a source of healthcare information. I would have even accepted one in five, as National Research put in their press release. How did CNN come up with 41%?

CNN and National Research share the blame on this one. If you take a look at the detailed spreadsheet with the full findings of the survey, you’ll see how this happened. Here’s the piece of the spreadsheet in question:

What you see here, at a glance, is exactly what CNN reported. 40.8% “use social media as a source of healthcare information.” However, upon closer inspection, what you see is that those percentages shouldn’t be percentages at all, because they actually represent ages. That is, among those who said they use social media as a source of healthcare information, the average age of respondents was 40.8. For those who don’t use social media this way, the average age was 47.8. I’ve clarified this with National Research and they confirmed that this is indeed what these rows are supposed to communicate.

So, regarding getting the details right, CNN should have been more careful in how they reviewed the results, but National Research has an obligation to report their findings in a manner that is clear and without errors. CNN still has the wrong (much higher) data in their article, which makes the findings of the survey seem even more sensational.

• BONUS…Issue 7: “Correlation versus Causation”: This issue wasn’t something that I observed with National Research’s work, but it is something I see all the time and, in fact, represents the most dangerous studies, so I’m going to include it here. The issue is when authors of surveys report a connection between results as causal versus correlated. It’s a finer, but absolutely critical point. Causation means that one thing caused another to happen. For example, I dumped a bucket of water on you, which caused you to get wet. Correlation means that that two variables are somehow related. For example, people who wear bathing suits are wet.

The causation part always makes sense to people, but the correlation bit is a bit trickier. Basically, the idea is that two pieces of information or variables tend to move in the same direction (positive correlation) or in the exact opposite (negative correlation). The other alternative, of course, is when there is no correlation and the two variables move independent of one another. So, using my “people who wear bathing suits are wet” example, this only says that people who wear bathing suits also tend to get wet (e.g., because they go in a pool). This isn’t always the case though, so the correlation might not be 100% because you don’t always get wet when you wear a bathing suit (i.e., you don’t go in the water). What this statement doesn’t say, however, is that wearing a bathing suit causes you to get wet. In addition, being wet doesn’t mean that you have on a bathing suit. The two pieces of information are related, but one doesn’t lead to another.

So what?, you’re asking. The issue is when we present correlation as causation. This is best shown with an example. One thing I see all the time is companies trying to figure out how much a Facebook “fan” (now “Like”) is worth. One of the studies that bothers me the most (and that got a massive amount of industry press) was a finding from Syncapse that showed a Fan was worth $136.38 (PDF of full study). The way it was reported all over was that for every fan you get, it’s worth an additional $136.38 in revenue to the company. That is, the very fact of being a fan caused people to spend $138.38 more on the brand than they ordinarily would. That means you could spend $136.37 to acquire a fan and you’ll still come out ahead if you were a marketer. That’s a big marketing insight. Hmmm…

Sound suspicious to you? It did to me, but I thought I was the only one since no one else seemed to want to point out the flaw and somewhat obvious observation. Being a fan doesn’t cause you to spend more  on the brand. You spend more on the brand than the average person because you like the brand. Because you like the brand, you become a fan. If you never use the brand or never heard of it, you’re probably not going to become a fan. So, your fans are made up almost entirely of people who spend more on your brand than average people…that’s why they’re called fans after all. Being a fan on Facebook doesn’t cause you to spend more. However, there is a correlation between being a fan on Facebook and how much you spend on the brand. They are related in some way (which is pretty obvious in this case).

Causation versus correlation. Don’t get these mixed up. Don’t accept any study that seems to mix these up.

Those are my issues with a lot of the research I see come out these days. Watch for it if you’re reading research and if you’re publishing any. I will be.

So, what’s the actual number? How many people actually use social media for healthcare information? I looked to Pew Research and Susannah Fox for this since I’ve been through nearly every single one of their studies and dissected each and consistently find the highest standards of research practices. I asked Susannah about her views on the National Research study and she had this to say: “It worries me that people are so eager to promote a sensational headline. The goal of research should be to help people make good decisions based on sound data. Facebook is not a dominant source for health information. Not even close.” I’m obviously in agreement.

Susannah was able to share with me some new data from Pew that isn’t published yet, but will be made public later this month.  She gave me some data from the 2010 version of the study, “The Social Life of Health Information.” You can access the 2008 version of the information here. So, here’s your sneak preview and the information that was shared with me for this post: “62% of internet users are on social network sites and, of those, just 15% get health information on the sites.”

What’s ironic about this, is that this actually sounds fairly close to the National Research findings. It turns out to be close…maybe…but it does highlight another subtle, yet important difference between the two studies. Pew asked people first if they use the internet and then, what percentage use social network sites (answer: 62%). National Research says: “1 in 5 Americans Use Social Media for Health Care Information.” However, they don’t account for Americans that don’t even use the Internet and those that use the Internet, but not social media sites. It doesn’t appear that they asked either question. However, it is an online survey, so I’ll assume that 100% of their sample uses the Internet, but 100% of Americans don’t. The next question should be: “Of those that use the Internet, what percentage use social media sites?” If they use social media sites, then you can ask “do you use social media sites for healthcare information?” If you don’t ask these questions, then you can’t claim “1 in 5 Americans” (which implies of ALL Americans) because what you actually are showing is “1 in 5 Americans who use the Internet and social media sites use social media for healthcare information.” Again, an important thing to pay attention to especially if you plan to compare the results of different studies…which you should never do.

So, before you go out and quote the latest survey, dig in a bit deeper. Dig in even further if you’re planning on doing something different based on the results. There are lots of well-intentioned studies that end up being misleading and, unfortunately, a bunch of intentionally misleading ones as well. I don’t think National Research’s study fits into the latter category, but it is a good illustration of the former. When you see a study like this in the future and aren’t quite sure about whether you should believe the results, feel free to share it with me on Twitter or contact me. I love seeing them and looking for what’s good and bad.

A while back, I wrote a post called “Why Your Facebook Page Doesn’t Exist,” which got a good response, but made a few people a bit nervous. I’m back to make more people even more nervous today. If you thought having a Facebook page that no one really ever saw was bad, how about if I tell you that no one sees your emails either? Ugh.

Well, I hate to be the bearer of bad news, but that day may be close courtesy of your friends at Google. With little fanfare, a couple of weeks ago, Google launched Priority Inbox for Gmail. Here’s a quick overview of what it is:

Two things…first, if you use Gmail, I guarantee you just went and activated this. Second, if you use email marketing for your brand or company, that video probably made you a bit uneasy. I activated this the second I heard about it and couldn’t wait to see how it worked. It didn’t disappoint. For those who didn’t watch the video, what Priority Inbox does (as its name suggests) is prioritize your email messages by highlighting the ones it deems most important. These most important emails move to the top of the list to a section called “Important and Unread” regardless of when they were received. It looks like this:

Handy, eh? How does it work? Simple really. Google took its really great spam filter and basically told it to do the exact opposite. Instead of finding the most useless messages (spam), find the most important. Its a brilliant little tweak that works really well. For now, this only works on the Web version of Gmail, but the concept is too powerful for it to remain exclusively there for long. Nearly every email platform and corporate email provider has spam filtering, so how long before they make the same tweak as Google and offer this same prioritization? For providers looking to grab some corporate market share, this is a nice feature that any client would probably like to add.

I can say that in my two weeks of using Priority Inbox I’ve noticed two things. First, it works almost perfectly, meaning it doesn’t categorize much incorrectly. You can correct it when it does so that it gets even smarter, so by now it’s running almost flawlessly for me. Second, all I could think about when I was using this was when I could get the same thing for my corporate email account on Outlook. It might be a little while, but know that it’s coming.

As a marketer, and one who works for a digital marketing agency that manages a lot of CRM programs for a lot of clients that includes a lot of email, Priority Inbox both excites me and scares the hell out of me. To be sure, for all the noise about social media, I’m still a big fan of email (see here: “Pharma Can Use Email Marketing to Improve…Everything“). Why am I a big fan with all the buzz about social media? Simple. Email sells cases. Period. It works. For now (and this might change in the very near future), there are very few tactics that can deliver as immediate, predictable, and measurable results as email marketing. Having said that, Google might just be out to change all that.

Remember, Google’s goal is to get you to use more of Google products. So, they continuously make them better and introduce new ones. As you use it more, guess what? You see more text ads that you eventually click on. When you do, cha-ching, money for Google. It’s a system that works really well for them and, frankly, for me as a consumer. It’s a fine tradeoff to be able to use Gmail for free seeing as it’s something I would gladly pay quite a bit for. Google’s goal is not to get your brand’s email opened or clicked. Their goal is to make Gmail better. Better means that it’s quicker and easier to use. One of the best ways to make it quicker is to help people sort out all the junk and get to the important stuff.

Need an example of an inbox that needs a little help? Here’s mine from last year that I showed for a post called “The 7 Biggest Mistakes in Digital Relationship Marketing:”

As you can see, there are a bunch of commercial emails that filled up my email inbox for just one day. One other thing…none of them are read. I don’t care about any of them. For most, I don’t remember when I even signed up for them and, frankly, I’m too lazy to unsubscribe from them (check out the cartoon at the end of this post for some additional perspective). Google knows this. So, with Priority Inbox, I never have to even address these anymore or worry about losing an important email amongst the clutter. In the two weeks of using Priority Inbox, only one commercial email has ended up in my “Important and Unread” section of Gmail. One out of probably 150. I’m not totally sure why that one ended up there, so I told Gmail not to make the same mistake in the future, which I’m certain won’t be a problem.

If you’re using email marketing for your brand or company, you should be a little nervous. The point you should notice by now is that I’m (and your other subscribers) likely not seeing your email. I’m not seeing it because Google doesn’t think it’s important to me. They’re right. While Google has marked some important messages with normal status, I can fix this by marking them as Important, so that the filter does a little better next time. I’ve done this for about 10 messages in the past two weeks. I can tell you that not once have I done this with a commercial email. I’ve also realized that I haven’t missed a single one. I haven’t been wondering where my email from company X is or when my regularly update from company Y is coming.

How does Google figure out which emails are important and which aren’t? Here’s how they explain it: “Gmail uses a variety of signals to predict which messages are important, including the people you email most (if you email Bob a lot, a message from Bob is probably important) and which messages you open and reply to (these are likely more important than the ones you skip over).” So, if you’re a marketer and want me to see your email, get me to do the following:

• Open your email
• Reply to your email
• Send you an email

Easy, right?

Nope. You probably notice the problem. There aren’t really any commercial email campaigns out there that invite people to respond back to the email (in fact, most explicitly tell you not to reply) and there isn’t any reason why I’d send an email your company’s email program. Let’s assume those are out of your control. There might be some other factors, too. Google doesn’t like to give away the full algorithm for any of its products so that no one can game the system. However, you can probably assume that clicking on a link in an email is probably important, but we don’t know for sure. So, the one factor that you know is important and you can affect is open rate.

Am I opening your emails? Probably not and no one else is either. According to Epsilon, email open rates are around 22% in their most recent data. Also, this data shows that the average click rate is 5.3% (down from last year) and yet the average volume of email sent per company is up 10.6% compared to last year.  Bottom line, companies are sending more email and people are finding these emails less relevant. Combine this with the birth of Priority Inbox and it’s a potential perfect storm for companies relying on email marketing.

Putting Priority Inbox aside, one goal for your email program is obviously to get people to open the email and probably to click on it. Epsilon noted that “Consumers are much more likely to open messages that contain relevant content based on their past behavior and preferences.” Are you making content that is relevant to people? If you’re sending emails about the latest sales on dresses to your male customers, you’re probably not hitting this mark. That’s pretty easy to avoid. How about ensuring that you aren’t sending me emails for engagement rings since I’ve been married for almost (17 more days) 8 years?  Those are just the basics. You need to invest a little to really understand your customers, record their preferences and past behavior, and create something that’s meaningful to them. It’s not impossible.

I’m not one to pat any airline’s marketing efforts on the back, but here’s a simple example of a highly individualized email from Delta in my post “Personalization and Individualization…What’s the Difference?“. This is all you need to do. If your current CRM database isn’t capable of collecting this type of information and automatically generating an email like Delta’s, then you need a new system. If it is capable and you’re not using it, start today (if you need help, feel free to contact me and find out how my company can help you).

For all you skeptics and cynics out there who are thinking that Priority Inbox isn’t worth getting nervous about, consider this. Gmail has more than 176 million users now (according to ComScore data). Go through your email database and see what percentage are Gmail users. I guarantee that it’s higher than what you’d expect. For my part, 16% of subscribers for the Dose of Digital White Paper and Presentation email list are Gmail users (PS: sign up here). Fortunately for me, these people must find the content of the emails relevant, as around 50% have opened one of the most recent emails I sent (which is around once every 4-6 weeks). This means that Google is more likely to put a future email I send in the Important and Unread section of these subscribers’ inboxes. If the emails aren’t relevant all of a sudden, I’d expect that to change pretty quickly.

And while, 176 millions users might not be enough to sway you (I’m not sure why though), rest assured that this type of feature will be coming to other email providers and platforms in the near future. Gmail today…everyone else tomorrow.

Besides creating better emails, what else can you do? I’ll give you one big tip that only those dedicated few who have made it all the way through this post are going to get. Thanks for sticking around. Okay, here it is. Right now, it seems like the thing to do now with email is to ask subscribers to Like you on Facebook or follow you Twitter. That’s fine. However, if you are like other marketers, you probably do more marketing via email than social media, so it’s critical to get the email stuff right before worrying about social media (this from me, who is “Director of Social Media”, so you know I think it’s important). So, how about asking your subscribers to do something different? Instead of asking them to Like you, how about asking them to increase the priority of your email?

What?

Assuming that your email didn’t land in the Important and Unread section of their Gmail, then you need to help ensure it does next time. You can do this by having them flag the message with a higher priority. If they do it, then the next time you send an email to this person it’ll likely appear in the Important and Unread section. I know what you’re thinking…that’s just one person…we’ve got thousands (or millions) in our database. Showing up in the priority section of one person’s inbox isn’t helping us. Well, you see Gmail is smarter than that. When enough people mark the same email as spam in Gmail or the same company’s emails are keep getting marked as spam by a bunch of people, guess what? Gmail eventually categorizes it as spam for everyone and sends it directly to your Gmail spam folder. Since Priority Inbox uses the same algorithms as Gmail’s spam filter, you can be fairly sure that it uses the same general idea. That is, if enough people increase the priority of a company’s emails, then eventually Gmail will classify them as important for everyone. So, maybe your next email should have a little diagram like this as a call to action.

If you read this and said to yourself, “that great, but it would annoy all the people who aren’t Gmail subscribers if we included this in an email to all of subscribers,” then you need a new email database or a new way of looking at the one you have. Even the most basic systems (including nearly-free Mailchimp, which I use for Dose of Digital) allow you to filter out people based on email address.  So, create one version of your monthly email that goes to people with Gmail addresses that includes whatever content you want plus this new call to action. For those who don’t have a Gmail address, send them the usual. [PS: the next step is to stop sending requests for people to Like you on Facebook who don't have Facebook accounts or who already Like you (or do you?), but that's a post for another day.]

So, there are a few ideas of what to do to get ready for Priority Inbox from Gmail and at the same time make your email campaigns more effective. As some parting inspiration, here’s a great cartoon I found that gives you an idea of how not to conduct your email program. If this reminds you of your program, Priority Inbox is the least of your problems.

[Click to enlarge] Courtesy of Brad Colbow.

Don’t be this company.

If you’re looking for more about digital marketing in pharma, register for the 2010 E-patient Connections Conference. This year’s conference features three different tracks: mobile, gaming, and, yes, social. I’m co-chairing the Social Pharmer track, so expect a different approach compared to the regular conferences you’re used to.

I’m also teaching a tutorial the day before the conference called “Social Media Accelerator.” This will be an interactive workshop that will provide a quick way to catch up on social media in healthcare, including a review of the most and least effective social media marketing programs across industries. You’ll learn about the social media platforms used by patients and physicians and discuss opportunities and challenges of social media marketing, including within the context of DDMAC regulations. You’ll leave with a “best practice” process for creating and approving social media programs within your organization. Bring your questions, as there will be some good discussion time.

Register for the conference and use code “rx2010” (no quotes) and you’ll get $300 off. As a further incentive (as if you need one), everyone who registers gets a free Zeo Personal Sleep Coach system and some other great gifts too.

Over the past year or so, many pharma and healthcare companies have jumped into social media with many trying their hand at Facebook. You can see the full list on the Pharma and Healthcare Social Media Wiki. Just click down to the Facebook section. There you’ll see around 50 examples (and I’ll be adding about 5 more in the next update). [Note that this post is applicable to every industry and isn't pharma or healthcare specific.]

Nearly all of these pages have one thing in common. They do not allow comments on the page’s Wall. There are a number of different ways I can argue why this isn’t the best approach, but the rationale often given to me by these companies are related to three things. First, they don’t want people to post adverse events on the page or, second, they don’t want people to post off label information about the product, and, third, they don’t want to deal with negative comments of any sort. In today’s post, I’m not going to argue why these aren’t great excuses. I’ll save that for some other time.

There’s another side effect of not allowing commenting. If you turn off commenting, you also turn off the Like function. You can’t have one without the other. Of course, the Like is far less “dangerous” than a comment, as you can’t add commentary to a Like on the Facebook Wall. You just Like it. That’s it. So, I think most companies would, er, like to allow Fans to be able to Like  individual Wall posts and updates, but they are not willing to allow commenting to make this happen.

The end result is that Wall posts and status updates receive no comments and no Likes. So, what’s the big deal?

First, let’s remember that most of your actions on Facebook will appear on your Wall.

For example:

Next, let’s say that you are the admin for a brand page (like Dose of Digital’s…sorry, couldn’t resist a promotion opportunity). When you do a Wall post or status update, what happens to it?

Here’s a recent one from Dose of Digital’s Facebook Page:

What you probably think happens (if you’re like most people) is that all of the “Fans” of your Page will see this post. But, it’s likely that the vast majority don’t and, in fact, it’s possible that not a single one of them sees it.

Once you Like (previously Fan) a Page, you essentially subscribe to updates from that Page. Of course, you’re not going to visit every Page that you Like each day, so Facebook makes it easy for you by having a feed of all these updates in one place. It’s your News Feed. This is what you see when you first log into Facebook. It looks a little like this:

Familiar, right?

Stay with me because I’m about to show you the problem you have by not allowing comments and Likes.

Many of you probably have never noticed the setting at the top of the Feed…

By default, everyone’s Feed is set to “Top News.” But what exactly is “Top News”? Before I explain that, I’ll explain the simpler option, “Most Recent.” If you click on “Most Recent,” your Feed will change to show, get this, the most recent updates, posts, Likes and comments (etc.) from your friends and the same from pages you have Liked. It’s strictly based on the time the update was made with the most recent at the top. Raise your hand if you thought that your Feed was showing content in this form by default. Those with your hands up, thanks for being honest. That’s what most people think.

“Top News” is a bit trickier and is also the default setting for the feed. In this setting, the Feed is trying to show you the content that it believes is most meaningful or interesting to you out of all the possible content from your friends and Pages you Like. That means that the newest item isn’t at the top, but rather the item with the highest EdgeRank. “The what?”, you say.

EdgeRank is the algorithm that Facebook uses to determine the order of items in your Feed. In the end, it’s really simple, as it has just three factors: affinity, edge, and decay. Fancy words, but here’s what they are. Affinity is basically the connection between you and the piece of content. The more times you’ve interacted with the source of the content (Facebook calls it an “object”) in the past, the higher the affinity. For example, if you comment on your sister’s Wall everyday, content from your sister will have a high affinity score because you interact a lot with her. Second is “edge.” It sounds cooler than it is. All that edge refers to the relative weight of objects. For example, a comment on a Wall Post probably carries more weight than a Like because it take more effort to post a comment. I say probably because this is the proprietary part of the algorithm. Last, and simplest, is decay. This is the time that has past since the object was created.

Multiply the individual scores for each possible object and then arrange the content accordingly. That’s how your News Feed is populated. Now you know. Sleep easy tonight.

Why should you care?

If you’re someone responsible for a brand Facebook Page, you should care quite a lot because EdgeRank is what is likely preventing anyone from ever seeing your content. The reality of the News Feed is that people browse the top entries and dive in when they see something interesting. Sometimes they’ll come right back to the News Feed and many other times, they’ll head somewhere totally unrelated based on something else they find. People certainly don’t read one News Feed item after another until they get to the end. If your content is showing up towards the top of people’s News Feed, you create a virtuous cycle. If more people see it, then more people comment and Like it. The more people that do this, the more their Likes and comments related to your content show up on their Walls, and therefore, their friends’ News Feeds. This exposes your content to more potential Fans who then Like your page and leave comments. This ensures that your content is even higher on  more News Feeds and so on. For example, I’m a Fan of Mashable on Facebook. Everytime they put out something new it’s right around the top 2 or 3 stories in my News Feed. It’s because I interact  with (read, comment, Like, etc.) many of these posts and so do hundreds of others.

So, the question is this: Does your content ever show up among the first few items on anyone’s News Feed?

To answer this, let’s bring back EdgeRank. First, affinity. If you’re like most pharma and healthcare brands, your affinity score is pretty low. Because you don’t allow commenting or Likes, people don’t interact with you very often. Maybe they read an Update (assuming they see it), but that’s it. Because you probably don’t do regular updates, they probably don’t even do this very often. Low affinity…check. Next is edge. Interactions that require a bit of effort rank higher than those that don’t. From my earlier example, leaving a comment takes more effort than simply Liking something. Similarly, posting a photo requires more work than a text update. You get the idea. Because the only thing you’re likely doing with your page is Wall posts (that are likely just text), there isn’t much edge. These are low engagement activities that score the lowest. People have to interact with your content to create more edge. Finally, we come to decay. If you aren’t updating regularly, then your Posts will always suffer from a low score here as well. The only way to improve decay is to make sure you have regularly updated content to increase the number of times that your EdgeRank is calculated for something new, which would have a higher decay score.

For those scoring at home, most pages will be zero for three. The consequence of this is that all the effort you put into building your Fans on Facebook might have been a complete waste. The point of having Fans is that you can communicate with them. The best way to do this is for them to see your new content. The place they see new content is in their News Feed. But your content probably isn’t in their News Feed. As far as your Fans are concerned, your page may as well have been deleted.

So, now that I’ve got your attention, how do you know if anyone is seeing your content? Facebook recently upgraded their analytics to let you see both the number and types of interactions with content (comments, Likes, etc.) and also the number of impressions. Facebook’s definition of an “impression” is anytime it serves (displays) a certain piece of content. It doesn’t mean that someone actually read it, but that it was there. The content could have been served in a number of places including user’s news feed, a visit to the Page, or through an Open Graph social plugin (which include many of the ones seen here). This is similar to how impressions for banner ads on websites are measured. That is, impressions are the number of visitors who could have seen the banner, not the number that actually saw it.

How do you find the number of impressions for your content? When you are logged into an account that is an admin for the Page you’re interested in, go to: http://www.facebook.com/insights. You’ll get to a page like this:

A word of caution here…many people have reported bugs with the data from these insights pages that cause inaccurate or missing data. It’s the best we have though, so stay with me. This is what the insights page looks like for a given Facebook Page:

I can tell you that for my Page, the interactions numbers are wrong, but let’s continue. If you click on the “See Details” link next to Interactions, you end up here:

What’s missing here and what we need to figure out the number of impressions is, well, the number of impressions. You see that for me, “n/a” is all that appears. There are two different explanations for this, which I’m working on figuring out which is true (or if both are). I’ll post an update to this post when I get an answer from Facebook. Explanation 1: Impressions are only available for Pages with more than 5,000 Fans. This was given by Facebook as the cutoff when they first announced that per post impression data would be available earlier this year. If this is the case, then most pharma and healthcare pages aren’t going to get impressions data. Explanation 2 (potentially related to explanation 1): Facebook answers an FAQ about this noting that “Per-post insights are only available on verified, authentic Pages. If your Page is not verified as authentic, then this feature is not available.” No mention of 5,000 Fans here. So, if you have less than this, then you might be golden. Unfortunately, Facebook doesn’t tell you how to verify your page in their answer. But, one of the reasons you read this blog is because you know I have to figure this stuff out. So, here’s a link to the form you need to fill out to get your Page verified (hat tip to Inside Facebook for this one). How long that takes or if it works is anyone’s guess.

If you can see insights information right now, then great. Is is what you expected? Higher or lower? On average, it’s a 1:1 ratio for impressions to Fans. That is, if you have 1,000 fans, your Wall Post, for example, will typically get 1,000 impressions. This isn’t because every Fan actually was served the content (much less saw it), but because some were served it multiple times. Remember, impressions don’t mean that people actually saw and read the content much less engaged with it. However, this ratio only holds true for brands that post quality content and that have some engagement from Fans. Remember, EdgeRank and how the News Feed works? You’ll get more impressions if your content is always at the top of people’s Feeds. You’ll get way less if it never shows up. The feed displays around 20 of the top pieces of content. If yours is the 21st based on EdgeRank then you won’t even get an impression. To get to the top, you need a high EdgeRank and we’ve already talked about that.

The big point here is simple. By not allowing comments and, therefore, Likes and by updating content rarely and making it mostly text, you’re all but ensuring that your Facebook efforts are reaching no one. Allow comments and with them, Likes. You may have to remove a comment here and there, but that’s okay. You can remove it as soon as it’s posted if you’d like. No harm done. To me, there isn’t a real regulatory risk if you act in good faith. If someone publishes something off-label, for example, to your Wall or as a comment to your post and you remove it at the first chance you get, do you really think that the FDA is going to penalize you for that? You can’t control what people put on the site, you don’t encourage or condone this type of information, and you act on it as soon as you know there’s an issue. I don’t get what the concern is. There are a handful of pharma and healthcare pages out there that have opened up commenting and the vast majority are handling it just fine. In fact, they’re getting people to actively engage with the brand for the first time. Rather than create a nightmare for the brand, it’s a dream come true. Imagine that.

So, does your Facebook page even exist?

About a week and a half ago, I wrote a post called “10 Things I’m Tired of Hearing About Pharma Social Media.” As you might imagine, it stirred up a little controversy (check out the comments and discussion at the end of the post). The big concern that some people had was that if we stop talking about these “10 Things” then some “beginners” in the area of social media will suffer. So, in response, I put together a post called “The Beginner’s Guide to Pharma Social Media.” It included a ton of resources for any beginners who really want to catch up. I also promised that I’d write the positive version of the “10 Things” post by focusing  more positive areas. That’s why today you’re getting “10 Things I’d Like to Start Hearing About Pharma Social Media.”

These are the areas where I think the conversation should be headed and where social media may truly benefit healthcare overall and also be a viable communications channel for pharma and healthcare companies. I wrote the first “10 things” based on near direct quotes I’ve heard from people regarding pharma social media. I’ll do the same here, but these are quotes I’ve yet to hear, but would like to.

10 Things I’d Like to Hear About Pharma Social Media

1. “Participating in social media is a risk for us, but we’re going to do it anyway because we think it’s the right thing for patients.”

Notice that I didn’t say,” the right thing for our market share.” It might very well be beneficial for market share, but that can’t be the only reason why you get involved. You have to get into it because there are people that can benefit from your knowledge about your products. I’m specifically thinking about cases, for example, where there is dangerously inaccurate information about your products published on a disscusion forum. If some random person on a forum somewhere says that it’s “probably” safe to take 10 of your pills at once and you know that this will kill someone, shouldn’t you say something? Here’s how I explained how pharma companies can do this in an objective and beneficial way during my FDA public hearing testimony.

2. “We’ve got a rock-solid measurement plan in place for our social media efforts.”

This would, of course, be in complete opposition to comments like: “there’s no way to effectively measure social media efforts.” There’s a way to measure everything. I explained this in the first “10 Things” post and recommended that you visit Olivier Blanchard’s site, which is completely dedicated to this topic, and read everything. Bottom line, if you can track it, you can measure it. If you can measure it, you can get to an ROI (or certainly very close to it and much closer than you are now). Here are 100 things you can start tracking right now. Don’t throw your hands up in the air until you’ve checked out every one of these.

3. “Our social media efforts are completely integrated into the rest of our marketing efforts.”

Ahh, music to my ears. As I’ve always said, don’t create a “social media strategy.” Create a great brand strategy and use social media as one of the tactics to deliver on those strategies. Nothing more, nothing less. When I say integrated, I’m not just talking about integrating with your website or even all of your digital marketing activities. I’m talking about everything. Online, offline. Remotely, in person. PR team to regulatory team. Social media can potentially support all of your communication efforts, but it has to make sense. No one should look at something you’re doing in social media and think, “where in the hell did this come from?”

4. “We’re using social media to prevent another Vioxx [or insert similar drug pulled from the market because of serious safety issues and leading to massive legal issues].”

Yes, this can be done. It’s not simple, but it can be done. Today.

For example, Google is able to predict with precision the future flu infection rates simply based on search terms and volume changes. Hear me discuss this in the following presentation:

Companies like CureTogether are starting to predict disease correlation and drug efficacy based on user-provided data with only a few hundred people in a database. A comprehensive monitoring plan with some powerful statistical analysis could pick out problems before they start. Simply explained…if your new drug is suddenly being talked about with keywords like “heart attack,” “chest pain,” or the like and you’ve never seen this in your clinical trials, you might have signal that something is wrong. It doesn’t mean that there is for sure, but it’s a valuable “canary in the coalmine” that could prevent a major issue.

But first, you’ll have to do some monitoring. A minor detail, I suppose.

5. “We’ve trained everyone in our company on social media and have opened up access to social media sites completely.”

I mean, seriously…you’re going to do this eventually anyway. Why not do it now? Pfizer just did. At least, they did the latter part. Either one would be a good start, but both would be a big step forward. I’m not sure how company leadership can ask their teams to deliver in “emerging” channels (I cringe to think people still call social media “emerging”) and yet block access to these channels. It’s having the exact same impact that preventing your scientists from reading new research papers would have on your R&D. Not good.

Yes, you’ll need to have some rules in place. And, no, productivity won’t suffer. If someone wants to slack off, there are plenty of places online where they can do it that don’t fit in the social media category. If anything, expect it to have a positive impact on morale, which may lead to better productivity.

6. “Social media is how we’re providing meaningful customer service to patients and doctors.”

Yes, it is that simple. Look at it this way: you already provide great service via your call centers, why not provide the same service using a slightly more modern communication technology called the Internet? For example, when someone sends out this tweet (which I promise is a real)…

…maybe you should respond. But how can you respond to this question effectively in just 140 characters? Answer: you can’t. But you should answer and point people in the right direction. Here’s what AstraZeneca responded with:

If people saw the complaint, give them a chance to see the solution as well. Chances are it’ll spread more through social media than the complaint.

7. “Social media has given us a chance to find our biggest brand advocates, so we can start talking with them.”

Yes, even pharma brands have big advocates. Of course, it also has big detractors. Once you get involved in social media, expect to see some of the latter. For an example, review John Mack’s post: “Patient “Unadvocate” Lays Siege to sanofi-aventis VOICES Facebook Page. Where’s S-A’s Social Media VOICE?” John narrates the story of how a Facebook page ran by a division of sanofi-aventis was barraged with negative comments about their chemotherapy, Taxotere, and its side effects. Without going into many more details or discussing how sanofi-aventis should have handled this, I do want to add in one wrinkle.

Instead of the page being dominated by anti-Taxotere comments, what if the opposite happened? There are certainly side effects with this treatment, but there’s also a huge benefit for many people. I’d venture to say that there are a lot of people out their that owe their lives to Taxotere. I’m also sure that these people would be happy to explain that to the world if they thought there was a reason, knew where and when their opinion would be helpful, and had an easy way to share their thoughts. Of course, there isn’t any easier way than Facebook, but the other parts are a bit more of a challenge. Or are they?

If you knew who these advocates were before there was a crisis, then you could turn to them and ask that they weigh in on the situation when something does happen. If you do this successfully, then you don’t have to fight these battles yourself, you let both sides of the story explain it in their own words. You’re free to add in your perspective to the discussion, but which will have more impact on the public’s hearts and minds: your “company line” about the product or an impassioned story from someone who was truly saved by your product? Get to know these people now and get them ready because I’m sure you’ll need them at some point. You can’t try to find them once the crisis starts. It’s too late then.

8. “We’re using our social media resources to do something great for patient advocacy groups.”

Let’s face it. The pharma industry has a lot of resources at its disposal. That’s one of the big criticisms from the public. They don’t like to see their prescription prices increase while they also see more and more commercials for drugs on TV. To them, the solution is obvious: cut the commercials and you can cut the price. Of course, these commercials aren’t cheap; a lot of resources go into making and airing them. At the same time, pharma and healthcare companies have talented people with deep knowledge in specialized areas like government regulations, marketing, pricing and access, managed care, and, of course, medical. And when pharma companies go public with something, people hear about it.

Why not use all of these resources for something more than marketing? Why not use it to create something that’s bigger than your products? Advocacy groups can use your help and you’re looking for a way to reach patients. Instead of figuring out all the legal issues with marketing your product via social media, why not use social media simply to help an advocacy group with their efforts? The benefit to pharma and healthcare companies should be clear. This eliminates many of the legal issues everyone worries about (no fair balance required if you’re not talking about a product), improves the company’s skill and knowledge about social media, and might actually generate some positive PR. Oh yes, and it’s helping an important cause. Some companies have dabbled in this a little bit (see examples on the Pharma and Healthcare Social Media Wiki), but most try desperately to connect the program with their product. Resist this temptation for once and see what happens.

9. “Social media is a great opportunity to hear directly from our patients so that we can improve our products.”

You wouldn’t be the first company in the world to do this. Starbucks and Dell are two that have used this concept effectively. They let people submit their suggestions for improving a product, the public votes on their favorites, and then the company actually does those things that have risen to the top of the list. Think about how great this is for everyone. Customers get a place for their voices to be heard and can see that the company is listening and taking their suggestions seriously. The company gets this positive sentiment, but it also gets product engineering, marketing, production, and operations advice…for free. The next big innovation might not come from your lab, but rather your customers.

For pharma, this might mean a suggestion on how to better explain how your product works, a formulation recommendation, or something simple, but with a major impact. Consider when J&J added different color options to it’s popular OneTouch blood glucose monitors. Sales went through the roof all because of a different color shell. While I don’t know for sure, I’d venture to guess that this idea came from a diabetic somewhere. Create a process around this concept and you’ll have a continuous stream of new ideas and innovations.

10. “We’re moved way past the Dose of Digital ’10 Things I’m Tired of Hearing About in Social Media.’”

That right. Until everyone is saying this, then we’re still going to be stuck. I do mean everyone. It’s not enough for one or two companies to move forward. Everyone needs to move forward together. We’ll all learn more together, have a bigger impact on patient health, press government regulations, and find new approaches that benefit everyone. And we’ll do it all more quickly than if we each go at it alone.

__________

So that’s the new list of what you should start talking about in pharma and healthcare social media. If you didn’t like the idea of not talking about certain topics, that’s okay, but then you do have to promise to start talking about these topics at the same time.

For those who know me well enough, you’re probably aware that I’m a bit of a cynic sometimes and that I’m not one to hold back my opinion (most times). Of course, if you’ve read this blog before and don’t really know me, you probably figured this out already. So, today I’m unleashing both of these parts of my personality on a topic that’s been bugging me lately.

The spark was following along with a couple different conferences on social media in pharma via Twitter and receiving (no exaggeration) information about and invites to no less than 5 future conferences about…you guessed it…pharma social media. Of course, I’ve been a part of a lot of these conferences in the past, but you might have noticed that I’ve cut down on my attendance and speaking recently. The reason is that I think we’ve run out of things to say and people who haven’t heard them. I know for my part that I feel like I’ve covered every aspect of social media as it relates to pharma on this blog in many, many posts. I know that I’ve read even more from others and heard a ton of presentations about this topic at many different conferences. Haven’t all of you too? (Voice your opinion in this poll and see what the result are so far)

What I’m not doing today is criticizing anyone out there who has been speaking or writing about this topic. Certainly, I’d be among the people who have covered this topic pretty thoroughly by now.

What I am doing is proposing is a moratorium. A moratorium on debating the details about pharma social media that we all know. There are ten of them that I’m going to specifically ask we stop talking about for one month (for starters) and see what happens.

It’s great if you’ve covered these details in the past, but you are hereby banned from creating anymore content about these 10 topics within pharma social media. If you have something new that is outside one of the ten areas, let’s hear about it. If you’re creating a presentation that doesn’t include any of these ten, more power to you. Share it with us. I’ll even post it on this blog for the world to see if you manage to avoid all ten.

So, do you think you can keep yourself from talking about these ten topics for just a month? I present these to you as almost near direct quotes that I’ve heard or read over the past 3 months…in no particular order…

10 Things I’m Tired of Hearing About Pharma Social Media

1. “Pharma is heavily regulated, so doing anything in social media is a challenge.” This is typically the first line of every invitation I get to every conference on this topic. We know. Pharma=regulated. Always has, always will. Whether it’s TV, print, face-to-face sales calls, and, yes, social media, it’s all regulated…heavily. Having said that, it’s not impossible for pharma to do something in social media, as some may suggest. I constantly see objectives for conferences that are something like this: “Determine ways that pharma can legally engage in social media.” Well, I’ve got 350 ways on the Pharma and Healthcare Social Media Wiki. 350 examples of pharma companies engaging right now in social media.

2. “Social media may be the ‘holy grail’ of marketing for pharma companies.” Feel free to substitute your own hyperbole for “holy grail” if you prefer, but you get the idea. I hate to be the bearer of bad news, but social media isn’t the answer to pharma’s marketing woes anymore than TV ads are. It may become a useful channel over time, but if you’re counting on social media to revive your floundering blockbuster or to launch your next one, you’re out of luck. Social media may become a valuable tool for other aspects of pharma company operations, particularly research (clinical and marketing), but it’s not going to be a powerful marketing tool that solves any marketing challenge. I’m not going to get into all of the reasons why, but this visual might help explain it.

Think you’re ever going to see that anywhere?

3. “Because of the rise of ‘e-patients,’ pharma needs to take an active role in social media.” To be clear, I’m not saying anything negative about ‘e-patients’ or the concept behind this term. That’s the last thing I need. Not sure what an “e-patient” is? Check out my prime example, E-Patient Dave. I love what Dave is doing and what he’s advocating, so that’s not what I’m proposing a ban on. Instead, it’s the connection of e-patients, social media, and pharma. Instead of e-patients being the reason why pharma needs to get involved in social media, it actually should be the reason they avoid it. E-patients will provide each other the information they need without the input from pharma companies. At the same time, make an enemy of some e-patients, and you’re done for…as well you should be. E-patients are important to the success of any pharma product, but you’d better bring something big to the table if you plan to focus your efforts on them. Just throwing together a Facebook page isn’t going to be enough and making it all about your products will likely backfire (again, as well it should).

4. “More and more people are turning to the Internet and social media to get healthcare information.” You know how on those legal dramas when the two lawyers are going at each other and then at some point they say something about “stipulating” something. That’s what I want here. Can we all just agree and accept the fact that, yes, the Internet is an important source of healthcare information? And, yes, some people, maybe even a lot or most people, use information found within social media as part of their healthcare decision-making. Haven’t we all seen enough charts from enough sources to say, regardless of which side of this argument you’re on, that you can stipulate that this is true?

I know I have seen enough and I’d imagine that you have too. How do I know? When I was presenting before the FDA panel on social media late in the day, after many other people, I came to my slides that included a bunch of these stats. Stats that had been shown about 50 times already that day. What did I do? I said that I was going to skip those slides because the point had already been made by others. The reaction from the crowd? Applause.

5. “With the impending guidelines on social media from FDA expected later in 2010…” This is going to not sound really nice, but if you’re following the developments of pharma social media use and haven’t heard about the FDA hearing that happened in November 2009 or that some guidelines might come out before the end of 2010, you’ve got a lot of catching up to do. These guidelines might come, but they will not write a marketing plan for you. They will not grant carte blanche freedom for pharma companies to do whatever they want in social media. In fact, expect them to be frustratingly vague simply because FDA can’t write explicit rules for every platform and activity you’re considering for the next marketing cycle.

We get it. Guidelines. Coming soon. Talking about that they might come and speculating what they might include probably isn’t much help at this point. It’s already pretty clear that some things can be done today (again, I give you the Pharma and Healthcare Social Media Wiki). Get out there and do instead of wringing your hands about what might happen. Or don’t.

6. “As social media grows in importance, it’s critical that you have a solid social media strategy.” Ugh. I should have listed this as number 1 in case people don’t make it all the way to number 6. This one makes me crazy. I’ll handle this one really simply. First, this doesn’t only apply to pharma. It applies to every industry, regulated or otherwise, selling pretzels or fishing line, liberal or conservative corporate culture. Listen closely: you don’t need a social media strategy.

Rather than write something new, I’m going to recycle a paragraph from one my personal favorite posts from this blog, “9 Simple Steps to Getting Started in Social Media.” Step number 1 includes this advice: “DO NOT define a ‘social media strategy.’ You should not have a social media strategy. Instead, you should brand objectives. This might  be something like ‘increase market share to 25% by December 2010,’ for example. In order to achieve these objectives, you’ve put together a set of strategies that will get you to those objectives. To deliver those strategies, you’ve come up with a number of tactics. Social media is one of those tactics. Nothing more, nothing less. If you create a social media strategy, it’s highly likely that your social media efforts won’t line up with your overall business objectives. This will make it even harder to measure the impact of these efforts or will outright fail. Perhaps you need social media, perhaps you don’t. Look at it as part of a larger marketing plan to figure this out.” Enough said.

7. “You can begin your social media activities by just trying something small.” Since I said, “ugh,” for number 6, I probably shouldn’t say it here, but if I could I would. Please don’t just do something social media related because you can. Anyone can set up a Facebook page for their brand in minutes and a Twitter account in seconds. Don’t. Yes, it’s easy, but it’s also likely a waste of resources. It might take a second to set up, but if you’re not allowed to use it, then it was a waste. If you are allowed and it takes forever to get content approved or rules on how you can engage with patients, well then your minute invest has turned into weeks.

So, while trying something is important and a good step, it’s not the first step. It’s the last step (of my 6 Steps to Getting Your Healthcare Social Media Idea Approved anyway). Try something if you’ve got everything else aligned and do it to test your process and not simply because you can. You’ll probably find that getting things approved is harder than you imagined. It’s good to know this now when there isn’t a crisis you need to respond to or after you’ve invested hundreds of thousands of dollars on a program. Don’t try anything. Do something with intent.

8. “There is a need for useful healthcare-related social media tools/content/platforms/communities that pharma companies can help fill.” What? There are so many things wrong with this, I’m not sure where to begin. I’ll just cover two though for the sake of time. First, there is not a lack of these things. Again, check out all the communities on the Pharma and Healthcare Social Media Wiki. If your big idea does not add something well beyond what some of these existing, established 3rd party communities provide, it’s time to put that big idea in the trash bin.

It might not be fair, but here’s the reality. It’s harder for a pharma company than, say, a neutral 3rd party (like a patient) to create something in social media that people value. A lot harder. Why? Well, here’s the “not fair” part: people don’t like pharma companies. They are trusted about the same as oil and tobacco companies (and remarkably, less than banks). So, in order for a patient to be part of a pharma-controlled community, he or she would have to put this distrust aside and willingly share personal information about themselves, their disease, and their treatments with “big pharma.” Seem like a bridge too far? It should. There are still some unmet needs out there, but going it alone probably isn’t a winning strategy for most pharma companies. If you build it, unlike in Field of Dreams, people won’t come. Finding a trusted partner who is established and neutral might be the logical path.

9. “Facebook/Twitter/YouTube/Something Else is the future of social media.” Pick your favorite and substitute it at the front of this statement. It doesn’t matter which you choose, I’ll still be making the same point. Here goes: Facebook is not social media. Yep, you heard me, and, yes, I’m familiar with Facebook. Twitter isn’t social media either. Nor is YouTube…you get the point. These are social media platforms. They employ the principles of social media, but a platform can’t be social media. They are simply a means to access the social part of social media. The connections and interactions between people and the sharing of information and data are social media. It’s the bridging of distance, time, and status to connect people together in support of a common purpose. That purpose can be anything, but the connection part is what’s critical. If you think that creating a Facebook page or Twitter account means that you’re “doing” social media, you’re wrong. If your social media doesn’t share in two directions, doesn’t connect people, and doesn’t treat everyone as equals, then you’re probably still just broadcasting. You may as well stick with TV and journal ads…less risky.

10. “Because of the unique nature of its business, measuring ROI for social media is impossible for pharma.” If a consultant or agency person comes to your company and tells you this, fire that person on the spot. No questions asked, just show them the door. Yes, it is hard to measure ROI (return on investment) in a meaningful way in pharma, but it is far from impossible. The rationale for this feeling of futility is two-fold. First, most people think that the ROI for social media in any industry is impossible. Add to this the fact that you can’t track which people actually filled a prescription unlike how you can track the use of, say, a grocery shopper loyalty card and it’s a perfect excuse. To be clear, measuring ROI for social media is possible and it’s done all the time. And for the record, counting the number of fans (or Likers, whatever they’re called today) you have on Facebook isn’t going to give you an ROI. It might be a first step, but you’ve got a ways to go.

If you really want to measure ROI for your social media efforts, visit Olivier Blanchard’s site, which is completely dedicated to this topic, and read everything. He shows that it’s more than possible, it’s expected. You can do it in pharma too and certainly as well as you can measure the ROI of a TV commercial. I’d argue that it’s far easier to measure the ROI for most social media efforts (namely anything digital) compared to any other pharma marketing channel. Period. I’m out of space in this post to demonstrate fully, but I promise to show you in an upcoming post (or contact me and my company will set it up for you).

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So that’s the list of 10 topics that you are not allowed to talk about for the next month. If you make it that far, then we’ll extend it. I’ll be watching to see who breaks the pact first. When I see it, I’ll call it out and I invite you to do the same. Just add the hashtag #smprotest and we’ll all know what you’re talking about.

If you’re with me on this and want to show your support for the cause, I invite you to proudly display this badge. Put it anywhere you think people will see it.

You can just save the file from here or use this little bit of code to embed it anywhere with a link back to this post.

<form><a href="http://www.doseofdigital.com/2010/06/10-thing-tired-hearing-pharma-social-media" target="_blank"><img src="http://www.doseofdigital.com/wp-content/uploads/2010/06/10_badge-sm.png"/></a></form>

Remember…I’ll be watching. Let me know if I missed anything, as I’d be happy to make a “15″ or “20″ badge if necessary.

I’ve talked about medication adherence a few times on this blog including some thoughts on how to improve it (most recently: “The Only Way Pharma Can Improve Compliance: Fun“). [Quick disclaimer: I'm using "compliance" and "adherence" a bit interchangeably in this post. I know they're different, but I'm going to spare a big debate. Just go with it. Thanks.] It’s certainly not an easy challenge and one that no one has figured out yet. There are certainly incremental improvements that have been made over the years, but we have yet to discover a “magic bullet.” But perhaps there isn’t one. Instead, maybe there are a number of different “cures” with one working for one person and another working for someone else. If we believe this is the case, then the only way to find these “cures” is to try something. In fact, we’ve got to try a number of different things, see what works, and throw out what doesn’t.

One area where I think a big impact can be made is in game theory. That is, using the concepts and theories of this field of study to help improve adherence. I’m going to cover this concept in more detail in an upcoming post, but the short version goes like this (via Wikipedia): “Game theory is a branch of applied mathematics that is used in the social sciences, most notably in economics, as well as in biology (most notably evolutionary biology and ecology), engineering, political science, international relations, computer science, and philosophy. Game theory attempts to mathematically capture behavior in strategic situations, in which an individual’s success in making choices depends on the choices of others.”

Classic Wikipedia definition, so here’s the English: Don’t worry about anything but the last part of the definition.  As you likely have observed, we humans don’t make perfectly predictable or rational decisions when it comes to health, but game theory could be used to figure out that these decisions might not be so irrational after all. There’s certainly application when it comes to medication adherence where even for life-threatening conditions, adherence rates remain startlingly low.

For those of you who read the last part of the game theory definition carefully, you might be a bit puzzled as to why this applies to adherence. It ends with: “…an individual’s success in making choices depends on the choices of others.” What do the choices of others have to do with your behavior especially when it comes to adherence? Again, more to come in future posts on this topic, but the short explanation is this: the decision as to whether or not to take your medication as prescribed is equally influenced by factors you develop for yourself as factors that others develop. In other words, the reasons you use to justify whether or not to take your medication come in equal parts from your beliefs and perceptions as they do from the people around you. You’re not the only one who determines whether or not you take your medication. Other influencers include spouses, children, doctors, nurses, pharma companies, friends, pharmacists, and many others (and in different orders for different people). Yes, ultimately, you have the final decision, since you’re the one putting the pill in your mouth, but you aren’t the only one with a say in what you do.

The question then is this: which behaviors of others have the biggest positive influence on a person’s adherence?

This is where the real gaming aspect comes into play. As humans, we are genetically programmed to want to be winners. There is no second place in evolution. For that reason, many of our behaviors are geared to ensure our genetic success. This is why find spouses and take care of our children. It’s a primordial drive in all of us. In most cases, we strive for our genetic success over others. This is far more pronounced in the animal kingdom where you can watch males square off (sometimes to the death) for the right to mate. We humans don’t exactly do this, but sometimes we do either literally or figuratively (see any reality TV show for examples).

Since we’re programmed to want to come in first, that means we’re similarly programmed to not want to come in last. This is one of the big motivators in game theory and the explanation behind the problem, Prisoner’s Dilemma.

The question is, can this same fundamental theory apply to medication adherence? I think it can. But first, you should know where this idea came from.

I recently read an article in USA Today, “Do you use more energy than your neighbors?”, that talked about how some electric companies were trying some innovative things to reduce their customers’ use of electricity (interesting…wonder if pharma companies would be interested in helping reduce their customers’ use of their drugs?). There are a few reasons why the companies are interested in doing this, but I won’t get into them here. It also turns out that these companies have tried a number of things, but finally hit on an idea that involved comparing customers’ electricity use to that of their neighbors. This is the basic idea of what it looks like:

(Image from: Treehugger)

Well, imagine that this was your electric bill. What would you think? Would this be enough to get you to make a change? It probably won’t make you run out and buy solar panels for your roof, but I bet it will be in the back of your mind when you leave a room and don’t turn off the lights. This bill would be pretty hard to ignore for most people and most would make some minor changes even if the changes were subconscious. Game theory at work…no one wants to be last. This is especially true when your identity is attached to last place. Of course, here the information is anonymous (i.e., no one knows which specific neighbors are included), but you know where you stand. While you don’t like to be in last, you also don’t want someone else to be in first place. The higher your use of electricity the easier it is for everyone else to exceed the average (mean) performance. After all, you’re the one skewing the average much higher. So, you reduce your usage to both move yourself up in the standings and also to make it harder for others to achieve what they want. This, of course, motivates others to perform even better. In cases like the electric bill where it isn’t a zero-sum game, one person winning doesn’t mean that everyone else loses, there are grades of “winning.”

This innovative idea was presented at a recent TED conference and you can see the presentation below if you want to find out a little more. However, for now, know that this program has reduced electricity use by around 2-3%. As USA Today put it: “While that may sound small, the savings add up. The Sacramento Municipal Utility District, which started sending the reports to 35,000 households in 2008, says the households saved enough energy in a year to power 800 homes for a year.” That’s meaningful. Over time, I’d expect that these numbers only improve as people do more to try to be among the most efficient.

Here’s the TED talk:

Now, let’s apply this same concept to medication adherence. Let’s say that we knew you were on a chronic medication and how often you took this medication. What if you got a report each month that showed how often you took your medication? What if this report not only had your adherence rate (actually compliance rate, I suppose), but also that of others taking the same medication? If you found out that your rates were well below the average, what impact might that have?

Of course, it’s not this simple…here’s why…

First, you need a way to track someone’s adherence. I’ve already told you that people don’t really use trackers, so we’d need a solution for that piece. Among big reasons why people don’t use these trackers is because they’re hard to use and there’s not a real motivation to use one. Plus, they aren’t fun. Now, if you knew you were in a competition against others and the only way to ensure that you got proper “credit” in this competition is to track your actions, would that motivate you to track your actions? The answer is “it depends,” but, to be sure, this is a proven, effective model to get people to track their actions. Look no further than foursquare. Make no mistake, foursquare is a game. Period. The only reason why people get so religious about checking in is to steal mayorships from others and maintain their own (and get badges). Take mayorships away from everyone and I guarantee that foursquare goes away overnight. So, perhaps by adding a little competition to the mix, you can get people to track their medication use. Alternatively, you can use pharmacy refill data as a surrogate for adherence.

Second issue…privacy. All of this, of course, would have to be opt-in…or would it? If all the data is de-identified and pooled, there isn’t a privacy issue. And if people are actively using some tracker, then you can ensure that there’s a proper opt-in. If you can show that people get a benefit from giving up a little privacy, you’ll also be successful.

A few more details we can consider: what if the report that people got wasn’t just the numbers, but also included tips for how to improve your adherence and also medication-specific stats on why taking the medication is important (e.g., reduced mortality rate by X%).

The question then becomes: is seeing your rates compared to others enough of a motivator to get you to change your medication adherence? It’s probably not for most people. While we don’t want to come in last place, we also choose not to be involved in some “contests.” Just having a higher rate probably isn’t enough bragging rights to make it worth the effort. So, let’s up the ante. What if the standings weren’t in compliance rates, but in years left to live instead? On average, we can show for some drugs that there’s an improvement in mortality or other outcomes by taking your medication as prescribed for as long as your doctors deems appropriate. So, instead of showing that you took your medication 45% of the time and the average was 65%, we show that your additional years of life gained from taking the medication was 1.2 and the average was 2.5. That’s a game worth winning.

This wouldn’t be an easy system to implement, but it could be done reasonably simply via smartphone applications. There’d need to be a little data crunching to get to the outcome data, but it could be done for a lot of medications (just look for the pharmacoeconomic data to get started). Stay tuned in future posts for more of my thoughts on how we can use basic game theory to improve all sort of things in healthcare. In the meantime, feel free to give me your thoughts and turn off some lights. You don’t want to be in last place, do you?