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Dec 8th 2009 

Monitoring Adverse Events in Social Media for Pharma’s Biggest Brands: Hopeless Task or Simple Project?

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Hopeless Task?

Today’s post was co-written with Melissa Davies, Healthcare Research Director at Nielsen in the Online Division.

Key Points Summary (detailed post follows)

  • Reportable adverse events are far less common than most people suspect. There are only approximately 166 reportable adverse events per day recorded across the entire pharma industry.
  • Even for the biggest pharma brands, there are very few discussion happening online that include a mention about the brand. Only 36 per day for the biggest selling drug in the world, Lipitor.
  • When you consider the number of discussions that might have a reportable adverse event, it would take a long time to find one for most brands. For example, you can expect one reportable adverse event every 2 weeks for Lipitor (for the site monitored in this study).
  • For many pharma companies, it would be difficult, but not impossible to do this monitoring in house, as some automatic filtering could simplify things. Using call center employees, who are already trained in how to handle these discussions makes sense.
  • There are three categories of discussions that need to be screened: those you could skim past relatively quickly, those that might give pause for thought but could probably be filed away or handled with pre-approved response language, and those that may require escalation depending on the company’s social media and customer response policies. The time required to screen all discussions depends on the mix of these categories.
  • Companies need to determine what and why they are monitoring. This means determining if you’ll monitor only your sites or which 3rd party sites as well. Finding adverse events isn’t the only reason. Correcting misinformation, understanding patient needs, and engaging in dialogue (e.g., answering questions) are also reasons.
  • If companies are only monitoring their properties, expect a very low number of discussions and even few discussions that might be considered reportable adverse events.

Detailed Post

In a first for Dose of Digital, today’s post was co-written with Melissa Davies, Healthcare Research Director at Nielsen in the Online Division. Not familiar with Melissa, you say? I bet you’re familiar with her work especially if you’re  a regular reader of this blog. Melissa was the lead author for the now famous “1 in 500″ white paper about the incidence of adverse events (AEs) in social media. This is the report that showed the Internet isn’t chock full of reportable adverse events just waiting for the first unsuspecting pharma company to happen by and be crushed by the deluge. Rather, Melissa and her team’s work showed that only 1 in 500 (0.2%) randomly selected discussions (blogs, comments, forum posts, etc.) contained all four criteria required by the FDA to be considered a reportable adverse event. If you want more detail on this then check out my post The Myth of Adverse Event Reporting and definitely get the original paper (PDF) from Nielsen now as well.

Those are some pretty strong credentials to help me out with a follow up to my recent post 166 Reportable Adverse Events Equals One Red Herring. To create that post, I asked Melissa to supply some more information about the original Nielsen study. The reason for this is because in discussions with many people from the pharma industry, I discovered that many knew the “1 in 500″ stat, but remained concerned about the volume of AEs out there. Their rationale was simple: 0.2% of, say, 50 billion is still a pretty big number. Without knowing the number of total discussions, the 0.2% number doesn’t mean much. That meant figuring out how many new discussions are generated each day (and it’s not 50 billion).

The answer came from Melissa, who dug a bit into Nielsen’s database to answer a seemingly simple question: how many new pieces of healthcare-related content are generated each day online? Nielsen monitors 1,350 sites that it considers to be healthcare-specific (and millions of non-healthcare sites too). Looking at these 1,350 sites over time showed that, on average, there are more than 83,000 new pieces of content generated each day on these healthcare-specific sites. So, at least we know it’s not 50 billion.

That was the inspiration for my post. 0.2% X 83,000 = 166. There are 166 reportable adverse events generated each day for the entire pharma industry to handle. 166 isn’t a lot to me when you divide the work to manage these events across all the companies out there. Yes, larger companies are likely to have more and controversial products might also have more, but 166 for everyone to share is a pretty manageable number.

Almost immediately after this post went live, I was contacted by several pharma companies looking for some more information. Specifically, many weren’t convinced that it was quite this simple. That is, it may be one thing for Nielsen to scan through 500 messages and come up with 0.2% and to show the total volume, but it’s quite another for a pharma company to screen the more than 83,000 new pieces of content by hand themselves each day. How could one company possibly screen every single one of these pieces of content each day to find the few bits that refer to their products? What time commitment would be required to find these needles in all these virtual haystacks? When it comes to a particular brand, should they expect to find a few adverse events? Dozens? Hundreds?

I saw another objection to social media igniting before my eyes, so I decided to stomp out the flames before they got out of control.

I went back to Melissa and asked if they’d be interested in doing some more detailed analysis to show that the volume of drug mentions for any brand is quite manageable. They agreed and the result is this post. As I mentioned already, quite a few companies asked me after my “166″ post for the volume of discussions for their products. However, as this is how the folks at Nielsen make a living, we weren’t able to do with this. Instead, we decided to do a random selection of three companies from the top ten US pharma companies. The winners of this little lottery were Lilly, GSK, and Pfizer.

For each company, Nielsen looked at the top-selling products for this analysis. From their dataset of healthcare-specific websites, Nielsen BuzzMetrics collected, on average, more than 83,000 new discussions per day for the first half of 2009. Within this, there are a number of discussions about theses top-selling products. So, without further fanfare, here’s a look at the average number of discussions per day for the top five brands from each of the selected companies:

[Click on the image for a larger view]

Average Brand Buzz Per Day for Select Top Pharma Brands

Across these 15 brands, there are an average of 45.4 online discussions per day incorporating a brand mention. The volume of discussion can vary widely by brand. One interesting revelation: top sellers are not necessarily the most-buzzed brands. Lipitor and Advair, for example, are the two best-selling drugs among the 15 brands in the US (in dollar sales) and yet fall squarely in the middle of the pack for mentions. The top-mentioned product was Lyrica, which came in at number 8 of 15 in product sales.

Of course, there are many factors that can affect conversation volume, including disease state. It is interesting to see that some of the products you might expect to have a lot of volume based on their “controversial” nature don’t rise to the top. Cialis and Celebrex immediately come to mind. For the former, you might expect more off-color discussions cropping up, which would drive volume, but keep in mind, Nielsen only reviewed healthcare-specific sites for this analysis (so, any mention of Cialis on, say, PerezHilton.com, isn’t going to show up). In addition, mentions that included obvious spam terms such as “buy online” were excluded. For Celebrex, you might expect more volume based on the product’s past controversies. This doesn’t appear to be the case. However, volume can also change suddenly – when there is news about a brand (bad or good), a new market entrant, a public event related to the condition (Breast Cancer Awareness Month), etc.

So, that’s the raw data, the question now becomes: If a pharmaceutical brand wanted to monitor all of this discussion for things like adverse events, claim expansion, misinformation – or even just to understand what consumers are saying about the brand – can it be done in a practical manner?

To start, some filtering can be used to automate part of the process. For example, messages can be filtered for mentions of brand keywords. That’s what was done for this analysis. Nielsen filtered the more than 83,000 messages and pulled out only those messages that contained one of the 15 products selected for this analysis. It’s a very simple filter that every basic screening and monitoring tool can handle. The rationale for filtering out discussions that don’t contain a mention of a brand is that with this, you can’t have a reportable adverse event.

The next step is then sifting through all the mentions of your brand. The chart below shows how many discussions per day, on average, each brand would have to manage. For Cialis, about 17 discussions would have to be screened each day. For Lyrica, on the other hand, 132 discussions per day would have to be screened.

When you apply the “1 in 500″ statistic to these numbers, you get a better sense of how often a reportable adverse event is likely to show up.

[Click the image to enlarge]

Number of Days of Mentions to Find One Adverse Event

Translation: It takes a long time before a discussion with a reportable adverse event pops up. For example, it would take almost a month’s (29.6 days) worth of discussions to find one Geodon reportable adverse event. At the same time, you might expect to find one for Cymbalta every 5 days or so. Two things come to mind: first, that’s a lot of discussions to review without finding anything. Second, rather than being a deluge of  reportable adverse events, most brands aren’t even talked about that much making it much less likely that there are reportable AEs out there that you’re missing.

Since you might have to go through quite a few discussions to find one that requires your attention, let’s see at what the screening process might look like. First, the time required will vary greatly. Some discussions can almost instantly be determined not to have a reportable AE, while others are going to require some more time and attention.

Taking a look at some of the discussions seen for Lyrica (the most mentioned of the brands reviewed), you can basically group the discussions into one of three categories: those you could skim past relatively quickly (as they lack even the most basic information), those that might give pause for thought but could probably be filed away or handled with pre-approved response language (if you were doing actual outreach and engagement), and those that may require escalation depending on the company’s social media and customer response policies (these are the Discussions with potential reportable adverse events).

Here’s one of each from Lyrica [note: quotes are unedited]:

Skim past quickly: “i am doing much better thanks hun…i have neuropathy and use lyrica as well as ativan it does help me / lyrica helps with fibro….my very best to you and hubby…happy holidays sweetie” – from healingwell.com

Requires some thinking: “Aren’t they basically the same drug? Lyrica is just FAR more powerful than Neurontin? My Neuro explained Lyrica is 8x more powerful than Neurontin and if he up’s the Neruontin and makes an equiv. does it will be about the same response?” – from neurotalk.psychcentral.com

Might require escalation: “I am on my second try with Lyrica. I am on 75mg twice a day. I had dizzyness and blurred vision both times. The dizzyness has subsided, but the blurry vision is still there. I am on my 3rd week and so far I haven’t noticed any pain relief. Using it in combination with Nortriptylene and Lorcet for nerve pain in my ribs.” – from healingwell.com

So, the screening and coding for the 132 Lyrica discussions might only take a few minutes or could take an entire day and several people’s efforts if they are sufficiently complex. It all depends on how many of each category you have.

Beyond simply filtering for brand names, it’s possible to automate the process by looking for keywords related to known side effects, and/or keywords related to negative perception. However, this step brings up two key challenges. First is that any unknown side effects (which are the ones a brand might be most interested in discovering through this process) are the true “needles in the haystack” since they will likely not be covered by established keywords. That is, you’re not likely to find the unexpected and serious events that can really impact public health if only look for known side effects. Second is the challenge of using natural-language processing to accurately detect sentiment around healthcare messages. The nuances and unique considerations within healthcare discussion make it very tough to train a computer to digest what patients and caregivers care most about. Many monitoring companies, including Nielsen BuzzMetrics, use keywords to identify messages about a brand, and then use manual analysis to read and code messages for sentiment and topics of discussion. Manual analysis means that someone has to go through all the messages by hand at some point and determine what’s important and what’s not.

A pharmaceutical company could consider doing analysis process internally. Social media messages could be automatically screened for mentions of particular brand names, and then sent to a team within the company for review and follow-up action, if warranted. Within BuzzMetrics, they typically find that an analyst can read and code about 100 messages per day. That doesn’t include any internal routing or follow-up communications with original posters that a pharma company might want its employees to do, which would take additional time. An ideal group to handle this at pharma companies are those people already staffing your call center and who deal with adverse event reports received via phone (and other product inquiries). While they aren’t on a call or otherwise have a lull in the action, each person can review a handful of messages and determine if any need action. If they do find one, then the information is already in the hands of the right people at the company. Call center reps are trained on which issues they can handle directly and which need to be escalated. They understand the chain of command. They have established scripts to use over the phone, and some of this language (or key themes from it) can translate to the online world. And, of key importance, they know how to interact one-to-one with customers – which is really what social media is all about.

Let’s also keep one thing in mind. This volume of mentions is basically for all the social media discussions on all the health-related sites on the Internet (English-speaking only). These sites range from massive (like WebMD) to personal blogs with small followings. So, if you choose to monitor everything out there, this data shows what you can expect. However, under the current regulations, you are not required nor obligated to monitor third-party sites unless you are somehow connected with the site (as a sponsor, etc.). This means that you are only required to manage the sites that you maintain, own, or otherwise control in some way. This includes assets like your brand websites, any blogs, YouTube channels, Twitter (if someone DMs or replies directly to you), Facebook pages, and unbranded disease information and community sites. If you already have any of these, you know that you aren’t going to get a huge volume of discussions whether they be blog comments or YouTube comments. Most of the pharma social media programs that I’ve seen have received only a handful of comments over their entire lifetime. Even the most ambitious and well-known properties such as J&J’s BTW blog (the best healthcare industry blog IMO) don’t get very many comments. Their last 10 posts have 13 comments combined (and 6 of these came from Marc Monseau‘s post “What’s the ROI?”). That’s 13 comments since October 27…not a lot to monitor. Of course, J&J might have gotten more comments than this and a few were removed in moderation, but based on what I know of this blog very, very few comments are not published.

The next question is: “why?” Why are you screening and scanning the entire Internet looking for adverse events? The answer might be simple. Perhaps you want to know what people are saying about your brand to help direct future communications. Maybe you’re actually going to talk back and not just listen in. You might also want to listen everywhere because of a genuine desire (whether legally required or not) to know everything you can about the safety of your product. You might be looking just to check for unexpected adverse events. Isn’t it better to find out early about a serious adverse event that keeps occurring and, yet, wasn’t seen in clinical trials? The longer you wait, the more lawsuits get lined up. Of course, more important than the legal issues, the longer you wait or the longer it takes to discover a new, serious adverse event, the more people who could be harmed or killed by the product.

Perhaps the other answer to “why?” might simply be to provide better service to customers by better understanding them. Not just to know about harmful effects, but to know about questions, misinformation, patient concerns about the medication, or about disease treatment in general. You can see from this and many other analyses that there isn’t a high volume of AEs in online conversation, so if we move past that, maybe better serving patients should be the ultimate goal of monitoring online discussions.

We’ve found that most companies actually do want to monitor everything that’s out there (before you do, read my post Why Pharma Should Forget About Social Media Monitoring), but they either lack a purpose behind their monitoring or they’re concerned about what they’ll find. The latter concern includes worrying about how to manage the volume of messages that are out there. However, this analysis shows that the volume isn’t unmanageable even for the biggest pharma brands and perhaps eliminates one more barrier to pharma and healthcare companies first observing and then participating in the discussions happening all around them.

Nov 10th 2009 

166 Reportable Adverse Events Equals One Red Herring

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With just a few days until the long awaited FDA hearings on pharma’s use of social media, the buzz in our little community has certainly picked up. Heck, there’s even a site to track it all courtesy of Fabio Gratton. If you want the latest about these hearings, this site is a pretty good place to start. You can get a bunch of logistics information, see the Twitter buzz, and even download the presentations of those people who have made them available (you can get mine here).

It’s all great. We’re finally going to have some guidelines around social media, which we all have been clamoring about for a long time.

Enter the cynic part of me. I’m not so sure that most people are going to be happy with the results of this meeting. I was talking with a client yesterday who asked if I expected the guidelines to be vague/ambiguous or specific. Presumably, the latter being preferable to marketers. Of course, the guidelines can’t really be specific. For example, they can’t say, “Do this, this and this on Twitter, but not this and that.” The guidelines HAVE to be vague otherwise they’ll be outdated next year as the technology changes. I wouldn’t have it any other way. Ultra-specific and highly directive guidelines is not what you want…trust me. Don’t you already have that with everything else? Have you seen a pharma print ad recently?

Boniva Readers' Digest July 2009

That’s 40% ad and 60% fair balance. Do you need more rules like this?

My point is here is that slightly ambiguous rules, will allow many marketers to continue to justify their lack of participation in social media. Sure, nevermind that their peers are already doing quite a lot (see it all on the Pharma Social Media Wiki). Doesn’t matter. They’ve always had one objection and they’ll continue to have it.

That’s right, you guessed it: “adverse events.”

I’ll say this, if I never hear the words “adverse events” from another brand marketer, I’ll live my life out a much happier and less stressed person. When I was a brand manager and social media really wasn’t all the rage as it is today, I don’t think I ever said “adverse event” one time in three years in the context of reporting. It was something that happened and we had a whole team just to handle them, but I didn’t concern myself too much with them as a marketer (thankfully, on a product with very, very few reported adverse events).I relied on more classic “rationale” when I didn’t want to do something…you know, things like “no budget,” “regulatory,” and “ROI.”

But now, that there’s social media, it’s a whole new set of “rationale.” Of course, the one that rises to the top is adverse events. To figure out a bit more about this, I informally asked some pharma marketing people about what they thought “adverse events,” specifically “reportable adverse events,” really were and was pretty surprised by the results. None of the five I asked knew the completely accurate answer. I realized that this might be part of the problem.

It became clear to me and I crafted this analogy: Being afraid of “adverse events” in social media is like being afraid of swimming right after you eat.

Someone always told you that if you went swimming right after you ate that you’d cramp up and sink like a stone and drown a horrible, if sated, death. Except you won’t. No one knows where this “old wives tale” came from or certainly the scientific proof for it, but yet it persists. There’s probably a hint of science in there…maybe you’re body is spending resources digesting the food that would ordinarily be used to help you swim, so therefore…well, you can see how these things happen. Same thing with adverse event reporting…someone heard that one time someone posted an adverse event on a website and a pharma employee saw it and didn’t report it. This employee was subsequently tarred and feathered, fired, spent 12 months in real prison (no white collar stuff) and the company was fined $1 billion.

Ah, urban legends.

So, knowing that there’s a bit of a misunderstanding about adverse event reporting, I’m going to clear it up with some good old-fashioned numbers that I know your average marketer (myself included) can relate to. When the guidelines come back from the FDA and you don’t like them, you won’t have the whole adverse event issue to hide behind anymore. If you still want that security blanket, then stop reading now.

[Important safety tip: I am not an attorney, much less your attorney, so this should not be considered legal advice.]

By now, everyone has seen Nielsen’s report on the incidence of reportable adverse events on health-related sites. If you haven’t, get the paper now. In summary, Nielsen pulled out 500 random posts from the massive amount that they monitor (more on that in a minute). They then analyzed these to see if any of them had a “reportable adverse event.” What do you need to have a “reportable adverse event”? Simple. You need four things: an identifiable patient, an identifiable reporter, a specific drug or biologic involved in the event, and an adverse event or fatal outcome. If you don’t have all four, don’t bother submitting it because the FDA won’t accept it. In their words, “[Without these four pieces] a report on the incident should not be submitted to the FDA because reports without such information make interpretation of their significance difficult, at best, and impossible, in most instances.” [ital. added]

Of the 500 posts Nielsen reviewed, only one (yes, 1) had all four criteria. That’s 0.2% for those scoring at home. So, 0.2% of all posts, should contain a reportable adverse event. Impossible you say? Here’s why it’s so low: the rate-limiting factor here isn’t what many people think. It’s not that the, say, identifiable patient piece is difficult because of the anonymity of the Internet, for example. It’s much simpler than that. Most of what you might think is an “event” is not required to be reported.

In the Nielsen study, they looked for events that would need to be reported within 15 days of receipt per FDA regulations. These are the most serious events and have the strictest reporting standards. Events that must be reported within 15 days are those that are BOTH serious/life-threatening AND “unexpected.” The former is pretty simple and includes outcomes such as “death, a life-threatening…experience, inpatient hospitalization or prolongation of existing hospitalization, a persistent or significant disability/incapacity, or a congenital anomaly/birth defect.” The latter, “unexpected,” is a bit trickier, but also is pretty straight forward. “Unexpected” is  “any adverse drug experience that is not listed in the current labeling for the drug product.” [Read the full code on FDA's site]

This means that if someone reports they got a headache while taking your drug, for example, and headache is listed in your labeling as a known side effect, then you do not need to report this in 15 days or any other day. If, on the other hand, they report that their hair fell out and that’s not in your label, then it might be reportable since it’s “unexpected.” However, it’s not serious or life threatenting, so it would not be required to be reported within 15 days. Events that are EITHER serious/life-threatening OR “unexpected” need to be periodically reported to FDA (hint: you’re already doing this). Drugs launched in the three previous years needs need to do quarterly updates on these types of events. Those drugs that have been around longer than three years need to do annual reports. For the purposes of this discussion, I’m really only considering the events that would fall under the 15-day rule (as did Nielsen), as these are the ones that are most labor intensive and require immediate attention. Those that fall outside this rule can use your normal channels for reporting back to FDA, which you’re doing already.

Most of the confusion I’ve seen is around this issue is around defining exactly what qualifies as an adverse event that requires action. I mentioned already that only 1 posting in the 500 Nielsen reviewed met all four criteria including the adverse event part. However, I asked Nielsen for a bit more information on this and got some great help from my colleague at Nielsen, Melissa Davies. She informed me that only 4 of the 500 posts had events that were reportable under the 15-day rule (i.e., an event that was BOTH serious/life-threatening AND “unexpected.”) . Three of these were missing one of the other criteria required for reporting, so you’re left with one in 500.  I’ve heard a bunch of debate about this study because it doesn’t consider some companies’ required due diligence around investigating reports that are missing one of the four components. For example, there might a company policy that says you must investigate to find a reporter’s name including sending them a direct message or email from the site where the event was posted. Nielsen didn’t (and shouldn’t) account for every company’s policy on this.

However, regardless of your due diligence policy, you can’t report something that didn’t happen. If there’s no adverse event, it doesn’t matter if you have the other three pieces or not. Show’s over. No need to go further. So, the way I see it, the absolute worst case scenario is that only 4 out of 500 posts are potentially reportable, which is 0.8%. That’s not a big number, of course, but how many posts are there every day? That would tell you how many potentially reportable adverse events there are in a month or year.

Nielsen shared with me a bunch of data for my FDA testimony. They shared that their BuzzMetrics product regularly scans more than 100 million sites. Around 1,350 of these are healthcare-specific and have some discussion component to them (blogs, forums, Q&A, etc.). These 1,350 generate almost 83,000 new posts each DAY.

Here comes the math:

Math problem #1: Multiply the total number of posts per day by the number of posts that contain adverse events that are both serious/life-threatening AND unexpected and have the other three criteria required for an adverse event  = adverse events generated per day that need to be reported in 15 days to the FDA.

Math problem #1 answer: 83,000 X 0.2% = 166

If you want to use the more conservative number…

Math problem #2: Multiply the total number of posts per day by the number of posts that contain adverse events that are both serious/life-threatening AND unexpected, but do not necessarily have one or more of other three criteria to have a reportable event =  the maximum number of adverse events generated per day that need to be reported in 15 days to the FDA.

Math problem #2 answer: 83,000 X 0.8% = 644

Let me put that to you another way…the ENTIRE PHARMA INDUSTRY, assuming they were responsible for EVERY SINGLE discussion online, would have to manage 166 reportable adverse events per day. Divide that out across the number of companies out and there’s not a lot of work for people to do.

Of course, you are not required to monitor everything out there and you only have to report events that are reported to you (which would include posts or comments on sites you manage or control) or events that you come across elsewhere online. Unless you’re a really fast searcher, then you’re probably not going to read through 83,000 posts a day (hint: that’s about one per second). If you only concentrate on your little neck of the woods, then you might never come across a reportable adverse event in months. How many posts or comments does your social media program get? Looking at what’s out there, not many. So, if it takes 500 posts to see one, then you might not see one in your lifetime.

The point of all this is simple. Are we really holding back everything there is to gain from properly engaging in social media because of 166 reportable events a day? Does that add up for anyone else?

Sep 4th 2009 

Crushing Pharma’s Digital Marketing Dreams–Part 2

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Part two of two…read part one first or this isn’t going to make much sense.

As a quick recap, a couple weeks ago, I gave you all a survey to find out what you would do if there were no rules in pharma digital marketing (read original post and see the survey here). Not just social media, anything digital. Here were the choices: Community on brand website, addition of user generated content, ratings and reviews, unbranded community, “enhanced” product claims, branded Twitter page, expanded search optimization, expanded disease state information, branded Facebook page, or brand blog. I also gave you a blank field if you wanted to put in your own idea.

With about 50 responses or so, here are the results (percentages represent the number of mentions opposite total mentions, each respondent could select up to three items):

what pharma marketers would do if there were no rules

Yesterday, I covered the biggest vote getters: community on brand website, addition of user generated content, ratings and reviews, unbranded community, and brand blog. Today, I’ll tackle the rest: “enhanced” product claims, branded Twitter page, expanded search optimization, expanded disease state information, and branded Facebook page.

First, “enhanced” product claims. While I didn’t explain exactly what I meant by this, I think everyone got the point. I was thinking, since there were no rules and no one to formally punish you for breaking them, you could simply say your product worked a little better than it actually does or maybe you could use that clinical trial of five people that showed a 100% response rate with your drug. You know, “enhance.” Of course, in a world where there are rules, the penalties for getting caught doing this are pretty stiff, as Pfizer found out this week with their $2.3 billion fine. No need to worry though, there’s no one to fine you in our imaginary world. Here’s the problem though. Over time, physicians and patients figure out the truth. They figure it out on their own and your competitors give them a helping hand (and rightfully so). Just like exaggerated claims in any market, eventually they are rejected and the companies that foisted them upon the public pay for it for a long time; not just in fines, but in credibility and trust. Without these two in healthcare, you’re pretty much done. No, no one is going to outright stop using Pfizer’s products tomorrow, but are they going to think twice? Are they going to lean in another direction? Probably. So, not to make this a lecture, but I think everyone here knows that “enhancing” your product claims isn’t a winning strategy. So, I’m pleased to say that this selection finished dead last in the survey with only a couple votes. You know who you are.

A branded Facebook page came in with 9% of the total votes, just behind brand blog. Here’s the thing, there already are branded pharma Facebook pages. So, what’s stopping you? There are brand pages for at least four brands including Nasonex (and their Don’t Blow It application), Reclast’s “On the Go Women” from Novartis, Marcia Strassman-Patient Advocate for Zometa (also Novartis), and the biggest of them all, with more than 100,000 fans, Gardasil’s Take a Step Against Cervical Cancer. There you go. Precedent. Tell your regulatory teams and legal staff. Of course, you might be thinking that you could make an even more branded page with all the features of Facebook activated. This might include the Wall and user generated videos and pictures. Are you sure you want to do that?

Of course, I’m an advocate for ensuring that whenever you borrow a platform like Facebook, you try to preserve all the functionality of the platform. I call it Expected Visitor Experience (or E.V.E.). Disabling the Wall on Facebook technically violates this principle because people expect the Wall to be active no matter whose page they visit on Facebook. Having said that, there are exceptions to every rule. Each of the branded pharma examples I mentioned have features like the Wall disabled. Maybe that’s okay. The two reasons why it’s disabled are, first, to avoid people posting reportable adverse events (even if they likely wouldn’t), but also because you can’t control what people write. Again, I’m not advocating that you ever censor negative, but fair, comments, but do you censor the rants against your company? Do you censor opinions about your products even if people haven’t tried them? Where do you draw the line? The pharma industry isn’t the only industry that disables the Wall. Check out all the brand or corporate pages you’re a fan of and see how many allow the Wall and other features to be used completely openly. Perhaps soliciting comments in other ways is better. You can moderate certain comments and then post them after making your policy clear. This can work for comments, pictures, and videos. Moderating is okay as long as you’re open and up front about it. Facebook is no exception.

Oh, and another thing, don’t just use Facebook because everyone else is or because it’s the hot thing. Like any marketing tactic, have an objective. Critically evaluate that objective and figure out if Facebook really is the right choice. If you’ve got a brand new product and are worried about building awareness, for example, Facebook might not work for you. No one is going to “fan” a page of a product they’ve never heard of. Just think about it before you jump in.

Next, with 8% of the votes, was “expanded” disease state information. In this case, by”expanded” I meant more in-depth, more detailed, etc. As a result…more valuable to everyone. I suppose I wonder why this didn’t do better in the survey. As best I can figure, this is one that you all figured you could do any way, rules or no rules. And, you’re right. If you truly keep the site unbranded (i.e., not mentioning a product), you can cover a wide range of information about a certain disease. Of course, many marketers (and not just pharma ones) feel like they have to mention the product in order to be successful. However, this isn’t always true. In cases where you’re the market leader, you can grow the market by educating people about the incidence and treatment options for your market. You know that if this effort gets more people to seek treatment, you’ll get a disproportionate share as the market leader. This was the strategy behind the unbranded educational site our company created for Ethicon Endo-Surgery called BariatricEdge. We knew that if we could get more people to investigate, and ultimately have, bariatric (weight loss) surgery, Ethicon Endo-Surgery would benefit the most, as they had a dominant share of the devices used for this surgery. If more appropriate candidates sought treatment, the company would meet its objectives. It worked.

What if you’re not the market leader? In that case, you’ve got to rely on a concept our company calls Marketing with Meaning. It’s a simple concept that I’ve talked about before. Basically, you all create products that are meaningful to people, but we argue that the marketing of these products should also be meaningful. Check out the site for a bunch of examples and more detail. One of the ways you can create marketing with meaning is by educating people. Educating someone about a topic that will improve their health is, of course, highly meaningful. You don’t have to mention your brand every other word for it to yield business results either. People are pretty smart and will go out of their way to figure out who brings them useful information. They’ll reward you for it. Physicians know who is doing the most to support educating patients and, with all other things being equal, will lean towards these companies’ products.

Having said all that, don’t recreate something that already exists. You could instead focus on aggregating information from a number of credible sources. Putting all the information a patient might need in a single place could be very useful and save them hours or days of searching. Get past the “not invented here” attitude and borrow from the best (with proper credit of course).

Next in the survey results was “expanded” search optimization with 7% of the votes. I’m hoping that this is another case where you all thought you could do this now, so why waste a vote in our no rules world when you could get away with so much more? Fair enough. I do hope that this doesn’t signal that search isn’t important to you. I’m not going to recount all the reasons why I think this is, well, crazy, as I’ve done it before, but suffice it to say, if you’re not using organic search optimization, you are missing a giant opportunity. Check out all of my posts on this topic here and here and here. The fact is that pharma brand sites routinely show up distantly, if at all, in search engine results for key search terms related to their disease states. Millions of people searching for answers are getting them from every source but you. So, I’m going to assume that this choice didn’t do well in the survey because you are on top of this and not because you think that building a branded Facebook page is more important and likely to have a bigger impact on product sales. Please tell me I’m right.

Last, but not least, is the branded Twitter page. Once again, why wait until there are no rules? You can do it right now. A lot of pharma companies have jumped on the Twitter bandwagon already. Some have done it with distinction and others have sort of given up already (like many new Twitter users). There’s even been one intrepid company who tried out the first pharma branded Twitter account, NovoNordisk, for their diabetes treatment Levemir. And here’s the famous/infamous (depending on who you ask) tweet:

race with insulin tweet

If you’re interested, you can follow @racewithinsulin now and see what else they’ve got to say. The two differing views on this are from the IgniteBlog and  John Mack at Pharma Marketing News. You can decide if this tweet represents “a historic day” or “sleazy Twitter spam.” I’m personally not a fan of this only because I don’t think any real person would talk like this. Yes, they might talk about what prescription drug they are taking (maybe), but they wouldn’t add in the fair balance. It’s just way too forced for my taste, but you’ve got to start somewhere.

Recently, the folks at Kru Research decided to find out how effective branded pharma tweeting might be. Definitely read their findings if you haven’t already. As a quick bottom line, they found that you could get as high as a 14% response rate using Twitter. Compare that to the response you’re getting from business reply cards (BRCs) or other opt in vehicles. I’m willing to bet it’s not this high. Kru followed people who tweeted about insomnia (read the report to see why) and 14% followed them back. The 14% represents people who followed back. Essentially, following back is like saying, “yes, I’m interested in what you have to say. Tell me more.” An opt in. Some of these were probably auto-follows, but many were people who decided that they would follow this account. Kru tested several iterations and found that a fellow insomniac (i.e., “patient opinion leader”) who had an unbranded insomnia website listed in her profile had the best response.

They did a lot of rigorous work to figure this out and it was only for academic purposes (and to provide better service to their clients too). So, my challenge to all of you is this: are you using the same amount of rigor when it comes to your actual brand, in real life, on Twitter? There’s a lot more at stake, so you should be testing with at least the same amount of detail as Kru Research did. You would in any other channel, so make sure you do it with Twitter as well.

I don’t think that Twitter for pharma brands is a non-starter, but I think it’s a tactic looking for a purpose. What’s the reason I’d follow you? What value could you bring to me? If we can’t answer that, then it’s not going to work. Using Twitter as a broadcast medium with no interaction with brand isn’t a long-term strategy. That’s not going to get more people to ask about or ultimately take your product.

So there it is, all the things you’d like to do if there were no rules. What I tried to show with this post and yesterday’s is that you can already do many of the things you would do if there were no rules. Companies have already tried them. For many of the other ideas, I wondered why you’d ever want to do them (like a community on your brand site). My point with all of this has been simple: the rules (or lack of clear ones) shouldn’t be a barrier to the programs you want to do within digital marketing.

Yesterday, I mentioned the McKinsey report, How companies are benefiting from Web 2.0, to show that brand blogs were the “Web 2.0″ channel that most often showed at least one measurable benefit. There was one other very  important finding from this study that I’ll use as my close (and probably talk a lot more about in the future). Here it is, the “most important practices for successfully using Web 2.0 technologies:”

Most important practices for integrating web 2.0 technologies

I’ll call your attention to the middle column, “customer-related purposes.” So, here’s my question, are you doing this? According to McKinsey, when it comes to successfully using Web 2.0 technologies, forget about incentives (which you can’t provide anymore anyway). Great news (I’m looking at you e-detailing). You can even place less emphasis on marketing your “Web 2.0″ initiatives to customers. In other words, you shouldn’t necessarily go out and market your new digital program itself (e.g., tell the world about your great new YouTube channel). Instead, the thing they found most important success factor was “integrating Web 2.0 with other modes of customer interaction.” That means  integrating your digital marketing with your offline marketing. How often do you include your company Twitter account in your DTC TV commercial? Are your sales reps mentioning your Facebook page? Does your print ad direct people to your YouTube channel? Do your sales aids show off your unbranded disease education site? From what I’ve seen, they don’t. However, that’s what apparently works best and it makes sense if you think about it. You’re not supposed to be marketing a program (e.g., your new Facebook page), you’re supposed to be marketing your products. A single marketing channel or tactic shouldn’t stand on its own, it’s supposed to be connected to every other tactic (or at least most of them). Essentially, you need to think about your leading edge digital programs just a bit more “traditionally” for a moment and ask fundamental questions about how it fits with your other promotional efforts. That’ll increase the chances that your program does what you’ve always dreamed it would.

I guess it’s all right to dream after all.

Sep 3rd 2009 

Crushing Pharma’s Digital Marketing Dreams–Part 1

Dose of Digital Mini White Paper

Part one of two…part two available tomorrow.

I came up with a challenge to all of you a couple weeks ago and now I’m going to report back what you all told me. I had a vision of  a world with no rules in pharma marketing (please read that post first or this one won’t make much sense). I also asked you what you’d do in this imaginary world. The reason for writing the post was simple. I was trying to show that it really doesn’t matter if there are formal rules regulating what we do in pharma digital marketing. Specifically, I’m trying to get everyone past the notion that we need some sort of formal blessing or 937 pages of rules from the FDA before we can undertake many of the new digital marketing tactics available including social media marketing. That’s the number one reason I hear from companies who aren’t trying anything in social media: “We’re waiting for the FDA to publish guidelines on social media before we do anything.” Well, if that’s you, then my one piece of advice is this: settle in. You’re going to be waiting for a while.

Rules or no rules, I’ve talked with many pharma marketers who know the programs they’d love to do if only they were allowed. Many dream of doing something innovative in digital marketing. So today, I’m going to crush some of the dreams you’ve had for digital marketing. I’m going to try to show you why that one program you’ve always dreamed about isn’t likely to be all that effective. Sorry to do it, but you leave me no choice.

My point from my post was that it doesn’t matter if there are official rules or not, the market will dictate what you can and can’t do. As a recap, here was the warning I issued in my original post (click to read it now if you haven’t yet, as today’s post won’t make sense without it):

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

After this warning, I gave you all a survey to find out what you would do if there were no rules. No rules at all regarding what you could do with your digital marketing. Not just social media, anything digital. Here were the choices: Community on brand website, addition of user generated content, ratings and reviews, unbranded community, “enhanced” product claims, branded Twitter page, expanded search optimization, expanded disease state information, branded Facebook page, or brand blog. I also gave you a blank field if you wanted to put in your own idea.

Because I couldn’t resist, I predicted in my post (after the survey) what you would answer. Here was my guess: “Something social media, probably the community on your brand website.” Tah-dah! I was right about that, but was surprised (pleasantly and yet confounded) by some of the other results as well. With about 50 responses or so, here are the results (percentages represent the number of mentions opposite total mentions, each respondent could select up to three items):

what pharma marketers would do if there were no rules

Tied for first place were community on brand website and addition of user generated content. So, these are the two things that the most number of pharma marketers would like to do, but feel they can’t because of the rules (or lack of clear ones). Let’s look at them one at a time. First, a community on a brand website.

I’m not really sure why this is most appealing. Essentially, you’d have a patient (or maybe doctor) community on, say, the Lipitor brand website. You can picture it: “Click here to talk with others who have tried Lipitor.” Presumably, there would be questions about the drug and side effects and people would be giving their honest opinions and probably saying a lot of things that would make Lipitor blush just a bit. People don’t like to censor what they have to say in discussion groups. There would also be quite a bit of negative too, which isn’t necessarily bad, but also a few rants (you know: “Pharma is responsible for poisoning the world, swine flu, global terrorism, etc.”). Here’s the thing with a really community; you can’t moderate it. You can’t, if you’re Lipitor, simply delete all the bad posts and all the rants. But do you want them on your site? I’m not afraid of a negative review here and there. Frankly, these add to the credibility of any site and is why products with one or two stars almost always outsell those with no stars (i.e., no reviews). Get the stats here. I’ve talked all about how this would work for pharma before. So, your community might not be something you’re really proud of especially when all the anti-pharma folks come out of the woodwork.

There’s another problem. People don’t like pharma companies. Sorry, but you probably knew that. They don’t really trust pharma companies all that much either. Sorry again. So, why on earth do you think they’d want to join your community instead of one maintained by a completely unbiased third party like WebMD? Why? What’s the value? When it comes to a branded community, you simply can’t offer anything they can’t get somewhere else. However, I think there’s a slightly different approach. I encourage everyone who thinks I’m wrong at this point to first read my post  Forget Communities, Create Channels Instead. What’s the difference?

“Communities, in their truest sense, are made up of a large number of equally important individuals meeting each other, sharing ideas, and communicating with and amongst each other.  While a community might have a community manager and / or a community leader, all people are – for all intents and purposes – treated equal.

Channels – on the other hand - still have many of the same aspects of community – the ability to communicate, comment, share ideas, and connect – but they are focused on a certain, designated group of content providers who formulate the thought leaders of the group.” Thanks again to Stephen Saber once again for these definitions.

Channels are lead by a handful of experts. The people that you really want to hear from. The people you know aren’t crazy or plain wrong and whose advice you know you can trust. In other words, a completely open community where everyone’s comments and opinion are equally promoted and prioritized isn’t valuable in most cases. A controlled environment where experts (unbiased ones) sift through the information and advice and release what’s valuable and create useful, credible content, is what people really need and tend to use whether they know it or not.

So forget about your branded community and figure out how to do a channel instead. Read my entire post to get more details.

Next, user generated content. You want to add it. Well, go ahead. What’s stopping you? The first example of this in pharma goes back to 2007. Way back then, before every pharma company was on YouTube, Novartis sponsored a contest called FluFlix. The contest was designed to help raise awareness of the flu and why it’s important to get vaccinated. (Funny that we’re doing the same thing two years later, no?)

This contest introduction video alone has had nearly 800,000 views. As best I can find, this is the most popular pharma YouTube video ever by about a factor of about 40. Of all the entries they received, they picked 60 as finalists. In case you’re interested, three winners each took home $500. Here’s one, so you can get a flavor:

This is all user generated content. A bunch of pharma sites have testimonials on them now. Also user generated content. At least two pharma companies are taking a similar approach to Novartis, including using YouTube, to solicit user generated content. There’s GoInsulin from Sanofi-Aventis and My Asthma Story from AstraZeneca. For now, all the videos on these two channels are obviously professionally produced. I don’t know when (if?) they plan to add more videos in the vein of what Novartis did with FluFlix (i.e., produced at home videos).

You can always do user generated content, you just have to moderate what’s actually posted on your brand site. Anything that’s inappropriate (like swearing or completely off topic) you don’t post. Anything that has off-label claims you can’t post.  Make this clear in the submission rules and you’ll get more of what you can use. Almost every single video submission contest or program like this, inside pharma and out, is moderated exactly like this. You can’t post everything and people get that. Just be clear about why you post some things and not others UP FRONT.

Now, if you want to add user generated content because you’d like them to say your drug works for an unapproved indication instead of saying it yourself, why bother? In our no rules world, you can say it yourself. So, you should have picked “enhanced product claims,” but you didn’t. You know that in the end, this is a losing proposition. Doctors and patients eventually see through this type of behavior and reject everything you have to say. Where are you then?

Coming in right behind community on brand website and user generated content was ratings and reviews. I love it. I can only assume that my two recent posts about the importance of ratings and reviews did the trick (see here and here). Since I’ve already talked about this before, I won’t go into it here (hint: read the posts), but suffice it to say, I think this is a big opportunity. So big, in fact, I think it’s worth figuring out how to do it even in the real world where the FDA does enforce the rules. There has to be a way to add ratings and reviews to a pharma brand site that the FDA will allow. One of you pharma companies out there just has to ask them how. Remember that part of the reason why you’re allowing these reviews is to answer questions that people who just started taking your product need answered. Questions that, if handled appropriately and quickly, could be the difference between them continuing on treatment or quitting too soon. No one wins with the latter, so we need to figure out how to prevent it. Ratings and reviews could be a big part.

Unbranded communities came in next in our survey. These are where you don’t have your brand all over the page and instead focus on providing a community and support for a specific disease state. Obviously, in the real world, not having the community on your brand page saves a lot of fair balance. In our world with no rules, you wouldn’t have to worry about this, so why not go for the branded version? My only thought is that you realized (rules or not) that patients might be more responsive to an unbranded effort. They’d somehow be more trusting, open, and willing to join because it doesn’t seem too commercialized. Really? Patients are pretty smart. It would take them about 10 seconds to figure out that the site was sponsored by a pharma company. So, you may as well be open about it. However, it does appear that eliminating any mention of a specific brand does make a difference, but maybe not for the reasons you think.

The single best source of information about PKU is on an unbranded community created by Biomarin. Biomarin makes Kuvan, a treatment for this disease. There’s a great community on this site and Biomarin made it happen. They don’t appear to be involved really in any way except for their company logo appearing on a few pages. Apparently, if you provide enough value, people will come. If you do it right and put patients first, they’ll come. And stay. Follow this model and you can do this right now. The rules don’t need to be suspended. Biomarin and many others have already proven it. Go to the pharma and healthcare social media wiki and see for yourself.

This leads me to my next point about communities. Look at the wiki. Are you going to create a community (unbranded or not) that already exists? If so, how about looking to partner with something already out there? Wasting money to create a community on your own might not be the best idea. If your competitor already sponsors the best community in your disease area, then you might have to look to a completely different tactic. There’s no reason to battle head to head. One more reason NOT to create the community you’ve always wanted is that people don’t want it. Josh Bernoff from Forrester looked at which disease areas would likely benefit the most from social media. If your area isn’t in the top right (or at least top left), you might want to look elsewhere. Here’s Josh’s original post and my take on it as well.

So, according to this, if you’re thinking about doing a community for people with thyroid conditions, you’re better off trying something else. On the other hand, if you’re thinking about something for obesity or certain “mood disorders,” then you might be onto something.

Next up in the survey results, and the final option finishing in double-digits, was brand blogs. There are only a handful of blogs out there from the pharma industry, but it’s much more common in other industries (and here). There isn’t  (as far as I know) a single product-branded, pharma blog in existence. I think this is a big missed opportunity. To be fair to the critics, many corporate blogs aren’t working well. Only 1 in 6 consumers trust corporate blogs. On the surface, this might tell you that blogs just can’t work. However, it should tell you that most companies don’t use them correctly. You can’t make them a 24/7 advertisement about your product and you’ve got to be committed to them. So, everything can’t be a brand message and you can’t let it die. Most blogs die after a short time or they have such irregular postings that they are not worth paying attention to. If you’re going to blog, then be committed. To quote the article linked above, “Launching a blog with nothing to say is like paying for a blank magazine ad … sure you own the space, but you’ve done nothing with it.” Trust has a lot to do with ensuring people that your blog isn’t self-serving and also that you’re going to be there for the long haul.

Why blogging? It’s the best way to create a one on one connection with people. They get to see who you really are and hear why you do the things you do. For those taking your product already, it gives them further confidence to continue their treatment and gives them a very simple thing to share with others who they think might benefit from your product as well. What would you include? How about patient stories, new developments about your product (i.e., research), disease state information, educational pieces written by a healthcare professional, etc. Just make sure it’s not all about your brand.

And, don’t take my word for it. McKinsey just released its report on How Companies are Benefiting from Web 2.0. Really good stuff and worth checking out. I’ll be referring to it quite a lot in the future. For now, check out this chart:

How companies are benefiting from web 2.0

In both the “customer-related purposes” and “working with external partners/suppliers” category, blogs demonstrated at least one measurable benefit more often than any other Web 2.0 channel. What else do you need to know?

That’s all for part one. We’ll tackle part two tomorrow and cover the remaining survey results and also the write-in candidates. I’ll also touch on one more really important piece of McKinsey’s report, their findings on the most important practices for successfully using Web 2.0 technologies.

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