As 2009 wraps up, I thought I’d give a sneak peek into what’s planned on this blog for 2010. Just as aside, I find it odd that we’re going into a year that had a movie made about it. Seemed like the distant, distant future in 1984 when 2010 was made. Sadly, we still don’t have a lot of the futuristic inventions from the movie and I don’t think we’re likely to make contact with any new life forms in 2010 unless they visit us or NASA has a really, big year.

Alas, all is not lost, for we do have the Internet and with the Internet comes blogs just like the one you’re reading now.

So, what can you expect from Dose of Digital in 2010? Sorry, no flying cars or meal-in-a-capsule type inventions here, but hopefully some content to help you become an even better marketer in 2010 and beyond.

Here are some of the major things you’ll see in 2010 from Dose of Digital:

• 10 Things to Inspire Pharma’s Digital Creativity — Just as the title suggests, I’ll show you 10 things that others have done (both inside, but mostly outside pharma) to inspire you to think about what’s possible
• New Year’s Resolutions for Pharma Marketers — It was a successful series when I did it to start 2009 (how’d you do keeping the resolutions?), so we’ll try it again this year. Here’s part 5 of last year’s, with links to the other four parts.
• The “Dosies” — Wondering which efforts in healthcare and pharma social media are the best? Wonder no more. Early in 2010, we’ll bring you The Dosies, which will award the best examples of social media in the industry from the list on the Pharma and Healthcare Social Media Wiki. You’ll even have a chance to vote.
• The Myths and Realities of Pharma Social Media — Ever wonder what’s real and what’s not when it comes to pharma social media? What should you worry about and what should you not? What’s working and what’s not? One presentation will pull it all together. That’ll be out in January to start the year right.
• Results versus ROI — Do you know the difference? If you do, then you’re in the minority.
• How Data Mining Can Save Lives — Did you know that all the data out there has the answer to a lot of the clinical questions we keep asking? You just need to know where to look. The question is: what should pharma do about it?
• What’s Your Homepage? — Chances are that the first thing people see about your brand online isn’t your homepage and yet you spent millions on it. The first thing they see is almost certainly something you don’t even control. What are they seeing and how can you do something about it?
• “We Hate Your Website” — I’m trying to write a full-size book this year and you’ll get to hear a bit about the process and have some chances to offer your feedback (and maybe get quoted in the final version). For some more detail, check out this page.
• “Digital Savviness” — Not a full-sized book, but a mini-book. Along with the book comes a web-based tool that you can use to access the “savviness” of your customers when it comes to digital and get suggestions on which tactics might be the best to reach them. The draft of the mini-book is done and the website is under development. For more on this, including my presentation on the concept, check out this page. Did I mention both the book and site are free to everyone?

That’s just a taste of what’s coming out in the first quarter of 2010. Who knows what the rest of the year may hold?

In the meantime, thank you for all your support and for making this blog more popular than I would have ever imagined. It’s been a great experience for me personally and I look forward to even more discussions in 2010.

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But, she did pull it off. She managed to get twelve industry bloggers to give their view on a deceptively simple question: “what would you recommend as the top learning strategies for Pharma and Healthcare marketers in 2010?”

Where to begin? Of course, I think all marketers have a lot to learn especially when it comes to digital (myself included), but also in many other areas. We all do. In fact, the opening quote Ellen used for the ebook was this:

“The illiterate of the 21st century will not be those who cannot read or write, but those who cannot learn, unlearn, and relearn.” — Alvin Toffler

So, I guess we all have something to learn. Personally, I got quite a bit out of this ebook. When people ask me which blogs they should be reading when it comes to healthcare marketing, the list of people that Ellen pulled together is pretty much the list that I recommend. Here are the contributors to the ebook:

There’s a diverse group of topics included in the ebook, but there are certainly some common themes and also different perspectives on similar issues. I’d invite you to read the entire ebook and share it with others. It’s a great way to start 2010 and a fine holiday gift from Ellen. Thanks to her for pulling this together and to all the contributors for sharing their unique perspectives and insights.

Best wishes for a great 2010. I’ll have lots more to get your year started off in a big way next week and in early January. Stay tuned.

Download the ebook here:

Best Learning Actions for Healthcare Marketers in 2010 (748 downloads)

As always, if you’d like to be alerted when I have new white papers are available, feel free to sign up just fill out the form below. Your information will only be used for this purpose and will never be shared under any circumstance.

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What?

You haven’t noticed them? Well, they are there. Go check it out for yourself and come back.

See. I told you they were there. Don’t feel bad if you didn’t notice them. You’re in good company. Most people don’t notice them. Like many forms of banner ads, they are simply ignored and since they are relatively new to Facebook and people are very focused while on the site, this is even more true. Of course, you may have checked and found that there are no ads on Facebook for you. Congratulations. You’re in good company again along with the millions who use browser plugins to disable all of these ads (myself included).

Oh, yes, people don’t click on them much either. Check out the results from several campaigns I’ve done on Facebook as experiments. The bolded line at the bottom is the aggregate. These campaigns ranged from very broad to highly targeted, but the results are the same…pretty lousy clickthrough rates. (PS: if you’re thinking about advertising on Facebook, lean towards paying per click versus per impression…no one’s going to click on them, so you should be fine.)

0.074% clickthrough rate. Not 7%. Zero-point-zero-seven percent. Not even a measly half a percent.

I think Facebook knows that this isn’t great and they’re trying to make up for this in a couple of ways. First, price. For all of these campaigns combined, I spent around $200. That’s not going to bankrupt anyone and that got me 614,000 impressions. That’s about $3 per 1000 impressions. Not horrible. Per click, however, I spent about $0.43, which isn’t go great seeing as I probably could have done A LOT better doing paid search on Google.

The second way that Facebook is trying to help advertisers (and users), is by ensuring that only quality ads are shown. Google does this as well by adding in a “quality score” to determine which paid search ads occupy the first couple of positions. You can’t just outright buy the first paid search spot. Over time, if no one ever clicks on your ad, it’ll start to fall regardless of what you bid for the keyword. This is good for users. It’s also good for advertisers. Yes, it makes their job a bit harder because they have to make more relevant ads, but they should have been doing this in the first place. So, even if they have to be somewhat forced into making more relevant ads, it still works out.

The way Facebook helps force advertisers to make better ads is through their rating system. Take a look at a selection of ads that recently appeared on my page:

As you can see, they’re all thrilling and well-targeted to me. Just a quick look through and what do I see? First, in ad #1, I can apparently become a timber wolf  judging by the color of this “person’s” eyes. Good news in ad #2, I’m this close to being a filmmaker, which I’ll just call a good fall back job for me if this whole marketing thing doesn’t pan out. And ad #3 features one of my most annoying activities of the Internet, “Mafia Wars.” If you’ve got a Facebook account, you’ve been invited to play this “game.” This is a blocked application for me (yet, I still get the ad for it).

Bottom line: nothing terribly relevant even though Facebook’s ad creation tool let’s you target the ads to point that literally only a handful of people would see it if you so chose. Between selecting for age range, network, location, and keywords, you can target these ads to an almost frightening degree.  But all this targeting apparently doesn’t matter based on clickthrough rates I’ve seen.

Okay, so back to how Facebook “forces” advertisers to make better ads and the point of today’s post. You’ll notice at the bottom of each ad is a thumbs up and the word “Like.” In the upper-right of each ad is an “X,” which is positioned just like the “X” in Windows programs. Here’s how it works…if you click the “Like,” then presumably the ad get some additional quality score, which might make it show up higher on the page (just like Google’s paid search quality score) and you might get more ads with a similar demographic target. What’s missing is a “Hate” or “Dislike” option, but the “X” actually serves that function. If you click the “X” to close the ad, Facebook wants to know why and gives you this pop-up:

As you can see, the “X” is basically serving as a “Dislike,” but you’ve got to be “in the know” in order to know about this (and now you are). Many people have complained about this feature and would rather see a “Dislike” button (myself included). There’s even a Facebook Fan Page called “Facebook, give us a dislike button” with more than 550,000 fans. It’s basically a petition to Facebook demanding this feature. Facebook isn’t known for being very responsive to its users demands, so this might happen, but only if Facebook decides on its own that it’s necessary.

Of course, Facebook, like many other media properties, wants to protect it’s advertisers. Presumably, if you give people a “dislike” button, then when people click it there needs to be some sort of repercussion. Perhaps with enough “dislikes” the ad has to be pulled permanently or the advertiser has to pay more to have it placed. Advertisers don’t like this idea, so their collective power puts companies like Facebook in a tough spot. Make the users happy by allowing them to get rid of the worst ads or make the advertisers (who pay the bills) happy by allowing them to put up any ad they want. You can’t have both. Right now, Facebook has the latter.

I don’t mean to pick on Facebook, as they aren’t the only media property with this dilemma and very few have given any sort of real power to the users to control the ads they see. But, imagine if they did. Imagine if this were required. That’s right, everywhere that your ad appears online, there are also “Like” and “Dislike” buttons. Those ads with the most “Likes” get shown more often and the advertiser pays less and those with the most “Dislikes” get shown less often and the advertisers pay more. The question for media properties then becomes: “can I afford to only have “liked” ads on my site?” That is, if advertisers pay less if people like their ads, will the media properties make enough money? Do they need the cash from the “Disliked” ads just to keep the lights on? To answer the question: “can I afford to?” my answer is “Can you afford not to?” People are already looking for (and finding) ways to block all these ads anyway, so why not increase the chances that they don’t block them by actually making them good?

What’s that you say? It’s not possible to make a banner ad that people want to see? Try this one on for size:

Told you so. There are ads that people want to see. The ad for Pringles you see (and probably clicked a bunch of times) was even the winner of the Gold Cyber Lion at the Cannes Advertising Festival this past year. It’s the highest honor you can get for digital work…and it was a banner ad. Fair balance, my company, Bridge Worldwide, created that banner for Pringles (we are the digital agency of record for the brand). [Read my post: "What Pharma Can Learn from Pringles" to hear more about how this ad applies to pharma]

Question: how many “likes” versus “dislikes” would the Pringles ad have gotten? To give you a clue, after the award was announced, a link to a demo of the ad showed up on several social media sites including Buzzfeed, reddit, and many others. It was all over Twitter to the point that the link to view the ad (click to see it in a page) was the 4th most tweeted link on Twitter that day. More than 200,000 people came to see the ad in 2 days…on purpose. That is, they went out of their way to see an ad. Can your ads do that?

Of course, not every ad can be “Can Hands” and certainly it wouldn’t be appropriate for healthcare, but the point remains that our ads don’t have to be mind-numbingly boring and distracting to users. The don’t have to be so bad that people just want them to disappear.

So, here are some current pharma banner ads. Unfortunately, I don’t have the animated versions (only the Premarin one has actual animation, the rest have “scrolling” fair balance only), but I can assure you that it doesn’t add much. Which would you “like” and which would you “dislike”? PS: You don’t have to “like” any of them.

The Premarin Banner (with the cloud) at least has some animation, albeit odd and “icky” animation.

I’ll just leave it at that rather than ask a lot of questions about what purple rain has to do with vaginal dryness.

So, which did you give a “like” vote to and which did you give a “dislike” vote to? I’m going to guess that none of them got a “like” vote, which would indicate you’d like to see more of a particular ad. I’d further guess that just about every ad here would have gotten a “dislike.” So, if we implemented a system where only “liked” ads are shown prominently and repeatedly and “disliked” ads were show less often and in less obvious positions, these pharma companies would be paying a lot more to advertise their products.

Sadly, there isn’t a system like this in place now…or is there? There is, of course, a de facto voting system already. If people like your ad, they’ll click on it. That’s a “like.” If people don’t like  your ad, they won’t click on it. That’s a “dislike.” So, how are your click rates?  Is the media property or your media buying agency telling you that your rates are good? Do you think they’re good? How many times did you click on the Pringles banner? Granted, I called attention to it, so more people clicked on it than might have in the “real world.” However, I didn’t make you click it twice or, say, all 97 times (you did make it to the end, right?).

People are voting on your ads. Not just your banner ads either. Your paid search ads, your TV ads, and print too. They’re also voting on the “advertising” your reps deliver to doctors and your marketing at conventions or conferences. People are always voting on your marketing. The question is: are you listening to how they’re voting? Are you making change s based on these “votes”? Maybe you’re just continuing as if you’re completely unaware that these votes exist.  Eventually, the voters will have their say and you might not like who they pick.

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First off, there’s a reason why patient participation was low. Your “average” patient certainly wouldn’t have known about the hearings. They weren’t talked about on the evening news and by the time they might have found out through some blog or industry journal (if they even read them), the registration period would have long since closed. Perhaps there were many more patients or patient advocacy groups that would have liked to have given their opinion. Of course, they still can, as public comments are open until February (all the info you need to do so is here). It’s unclear if any patients have actually taken the time to do this. However, you can probably bet that your “average” patient isn’t going to be the one who writes comments to the FDA. By “average,” I mean your parents, your friends, not patient bloggers or advocacy group leaders. This is fine. There’s nothing wrong with these leaders being the only patients who submit comments. I love the fact that these leaders exist and really, truly speak on behalf of the groups they lead…nothing in it for them, no ego, just trying to do what’s right for the group. Names like Manny Hernandez (TuDiabetes) and Gilles Frydman (ACOR) come to mind as two great examples.

What’s my point? Where am I going with this?

Well, a lot has been made recently on many blogs and Twitter that the hearings, and by extension, the guidelines that come from these hearings will be completely devoid of any feedback or consideration of patients, who will be the ones really impacted by the final decision. I’ll quote one very representative view (which ironically includes a quote from me), which comes from my friend, John Mack in a recent post (quote in italics):

At the November, 2009, BDI Forum in New York City (“Healthcare Social Communications Leadership Forum Breakfast”), a question from the audience to a panel I was part of got to the core of the value of pharma to online patient communities. The question was “Should pharma be in discussion forums or lists frequented by patients? Do we need an industry consensus where we shouldn’t go?”

My colleague on the panel, Jonathan Richman (@jonmrich) noted that some consumer advocates speaking at the recent FDA public hearing said that under no circumstances should pharmaceutical companies be allowed to engage consumers in discussions on social networks. Jonathan thought that was too extreme. He suggested a few examples where such discussions could bring some value to the online patient community. He said there is data to suggest that patients/consumers would value the discussion if done the right way.

The problem is the TOTAL LACK OF PATIENT REPRESENTATION in this discussion! We’ve heard opinions of agencies and seen data from studies sponsored by agencies, but what are the views of real patients who have been using social media for years? [italics add, bold and caps his]

You can go to John’s blog to see my response, as it’s not really important for my point today. Let’s be clear. I agree that patients should have a voice and that the FDA should want their opinions.

Here’s where it gets controversial: patient feedback in the guideline development process is not at all necessary. The guidelines, whatever they are, will have very little impact on patients.

Now, before you alert the authorities, let me explain. First, to be sure, I don’t want pharma to turn social media into a free for all of advertising. I was pretty clear about that in my testimony for the FDA (download my presentation for “Question 3″). While I said that pharma should be able to participate, I was also pretty restrictive on how they should be allowed to do this. One of these restrictions was that pharma shouldn’t be allowed to just jump into conversations unsolicited. Rather, they can (and should) get involved in discussions where there is a question about one of their brands or some misinformation about one of their brands. Wouldn’t this be seen as a positive versus a negative if done appropriately? On the other hand, trying to sell a product shouldn’t be allowed or encouraged. For example, when someone says, “does anyone know which treatment is best for depression?”  I don’t want to see 25 pharma companies come out of nowhere and give the details on why their product is the best. That is, I don’t want pharma to have unfettered authority and access to do whatever they want online in social media or any other place.

Back to patient feedback on the guidelines. I’ve read a few great patient posts on this (here and here are couple of them). It seems to me that these patients are pretty much in agreement with me. Many say that they don’t want pharma involved at all in social media (which seems like an unlikely outcome). Others Iv’e read seem open to some involvement. Now, here’s why the guidelines will have no impact on patients.

Social media is just that: social. No one is in charge. No one has a higher rank than anyone else. It’s democracy in action. Yes, there are people who are more influential than others and can drive the community in one direction or another, but in the end, the people, whether they be patients or buyers of computers or new mothers, decide what happens in the community. They decide what’s credible, who they listen to, who gets “air time,” and, most important, who succeeds and who fails. Those with more influence aren’t the new members of the community (as pharma companies would be). They are long established members who people learned to trust for a number of reasons. That’s how social media works.

So, picture this: guidelines come out and pharma is allowed to do whatever they want in social media. Does this mean that they actually can? Say a pharma companies joins Tu Diabetes, for example, and inserts itself into a conversation about a particular treatment. If the community doesn’t want them there, that’s it. The show is over for the pharma company. People will ignore them, block them, report them, flag them, and everything else you do to people you don’t want in your community. The community polices itself. That which is not valuable or valued is ignored and rejected. That which is useful and beneficial rises to the top. Which direction do you think the average pharma company would find itself heading in these communities?

This is why I say that patient feedback into the guidelines isn’t necessary. All the guidelines do is give a guide to what is legal and what’s not. They don’t give a guide as to what’s effective and what’s not. A pharma company trying to insert itself into a conversation where it is not welcome will never be effective regardless of what’s actually legal.

In fact, in the end, patients have the most influence on the guidelines. Far beyond any pharma company or agency or government official, the end user, the patient, decides what’s effective, what influences them, and what’s meaningful. Patients don’t care about guidelines. They care about the quality of the discussion and the support they get from others. Do you think they’re going to let pharma companies get in the way of that?

Granted, some patient groups might prefer to nip this in the bud right now by banning pharma straight away from these discussions and avoid the trouble of policing it later. That’s not realistic though. So, in lieu of that, patients should be speaking with their actions in social media and not with their feedback to some set of government guidelines (which may never come). Sure, patients should absolutely submit their feedback to FDA, but they can have far more impact in social media with their actions. There are hundreds of examples from other industries of consumers destroying a company’s social media efforts when they find it useless, insulting, or just plain annoying. Why would patients behave any differently?

If pharma companies come to social media with the same promotional tactics that they use on TV and print, they will fail miserably. Who will see to it that they fail? Not the FDA. Not some set of guidelines. Patients will.

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Some efforts, naturally, are more ambitious than others, but one thing is clear: the lack of official guidelines isn’t stopping anyone from embarking on some social media efforts. This list is my single biggest rationale I give each day to people who ask: “how can I do anything without some guidelines?” I simply direct them to the wiki and add in the fact that not one single example on the wiki has ever received a warning letter. Read that last bit again…not one.

So, is it really as risky as what you think? Do people really not know what’s permissible and what’s not? No and no. If either of these were true, I think we’d be seeing a lot more letters. What’s stopping you now?

This is the final update for 2009, so a special thanks to everyone who has contributed throughout the year. It wouldn’t be much of a list without your efforts. I’ve done my best to give people credit for their submissions throughout. However, if you see someone else’s name credited to a submission you made, know that I only include one credit per entry and it’s the person who submits it first. For new examples, I’ll get as many as four or five submissions. That’s a testament to how closely each of you monitors this space and also how dedicated you are to sharing this knowledge with others via this wiki. Thank you for that.

Ironically, the wiki started with 25 items, but today’s update alone includes 36 new items. Some highlights from this update:

• Four new entries for AstraZeneca including two new Facebook pages, their first corporate YouTube channel, and a Twitter account just for job recruiting. They’re making a run at the top social media user among pharma companies.
• Pfizer added two new examples including a blog and YouTube channel
• Sanofi-Aventis gets one more entry with their new iPhone app, GoMeals
• I added 3 great industry-observer blogs that I’ve somehow forgotten to add in the past (even though I read them all)
• Included three blogs from the Mayo Clinic that should be the standard against which all other healthcare industry blogging efforts should be measured
• Five more additions to the list of pharma and healthcare companies using Twitter, including one branded effort

Stay tuned in January for the next update. In the meantime, you can submit your recommendations for inclusion (including your own site) using this form. Please read on for more information on what you can do to help support the wiki and ensure it continues to grow.

Here’s the link:

Pharma and Healthcare Social Media Wiki

If I sent you a note saying that you’d be included in the next update and you don’t see your listing, you’re in the queue for the next one.

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

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

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

Option 1

Copy and paste the code below onto your site:

<form><a href="http://www.doseofdigital.com/healthcare-pharma-social-media-wiki/" target="_blank"><img src="http://d2pa1q4iz3ea7o.cloudfront.net/wp-content/uploads/2009/08/doseofdigitalwikibadge1.jpg"/></a></form>

Option 2

Copy and paste the code below onto your site:

<form><a href="http://www.doseofdigital.com/healthcare-pharma-social-media-wiki/" target="_blank"><img src="http://d2pa1q4iz3ea7o.cloudfront.net/wp-content/uploads/2009/08/doseofdigitalwikibadge2.jpg"/></a></form>

Again, thank you all for your contributions. If you have any suggestions on how to improve the wiki, please let me know.

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As someone who’s spent a long time working in pharma, it becomes hard to look beyond the industry sometimes. Fortunately, I get a chance to work with and see a lot of work from our diverse client roster here at Bridge Worldwide. However, I’d like to get some unbiased expertise and completely new thinking. So, I created a survey called: “What should pharmaceutical companies be doing in digital marketing?”

Your answers will be part of an upcoming blog post. Only select answers will be published, but if you complete the survey, we will send you a copy of every answer received if you wish.

So, as I mentioned, I’m not looking for pharma people to answer this survey. “Pharma people” includes industry employees and partners (like agencies). If you work directly for or with a pharma company, then we can’t use you this time.

If you are a non-pharma person, then please take a moment and complete the survey. Also, feel free to forward it to anyone you think would have some good perspectives here.

Thanks in advance for your participation and for sharing this with others.

The survey form is embedded below, but if it’s not loading correctly, you can follow this link: http://ow.ly/KYBQ

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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]

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]

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.

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1. 166 Reportable Adverse Events Equals One Red Herring
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As we head into a long Thanksgiving weekend (in the US at least), I thought I’d write a quick thank you to everyone who has supported this blog in 2009. It has far exceeded my expectations and I continue to be amazed and flattered by the comments I receive via email, Twitter, and, more recently, in person. I launched this blog very late in 2008 with a few test posts, but really started dedicating time to at the beginning of this year. As a special thanks, read through to the end to get a special offer for all my dedicated readers (and if you’re reading this during Thanksgiving break, you’re dedicated).

In 2009, almost 50,000 unique visitors have stopped by and almost 1,200 of you are subscribers. I was doing a little analysis and found it interesting to see what the most read posts were for 2009 to date and thought I’d share this with you.

• By far, the number one post isn’t a post at all, but the Pharma and Healthcare Social Media Wiki. Not surprising for those of you who are regular visitors. I’ve seen the wiki referenced hundreds of places since it launched in February with about 20 examples of pharma social media. Now it has more than 450 (including industry observers, like me). I owe many of the submissions to all of you, so thanks for your contributions. The wiki has been viewed well over 30,000 times since it’s launch.
• One of the most tweeted posts of the year was Ten Digital Marketing Ideas Pharma Companies Will Never Try (But Should). It is also the most read post of the year and remains one of my personal favorites.
• The most commented on post of the year so far is Pharma Should Forget About Social Media Monitoring. It’s also the second most read post. This one generated quite a bit of debate on both sides, which, frankly, is what I was hoping would happen. It’s an important topic that needs to be discussed even further.
• One of my favorite titled posts, FDA Uses Social Media, But You Can’t, is the third most read post so far in 2009. This was published long before any of us thought the FDA would actually have a hearing on social media and this post surprised quite a few people who were amazed to see how much the FDA and CDC were doing with social media themselves while we all sat on the sidelines.
• One of the posts that got the most interest from non-pharma people was my post on How to Avoid FDA Regulations Using Mobile Marketing. Quite a few blogs in the mobile marketing arena picked up on this and sent a lot of visitors making it the number four post of the year so far.
• The number five post of the year so far is one of my personal favorites as well: The Myth of Adverse Event Reporting. I wrote this way back in January before there was much debate on AEs and how to handle them. This was one of the first posts to refer to the Nielsen data on the incidence of adverse events in healthcare social media discussions that everyone is now so familiar with.
• The most downloaded white paper of the year so far is The Future of Healthcare Relationship Marketing with 1583 downloads (and counting) so far this year.

And speaking of white papers, I’ll be releasing one next week that will include two posts that will also come out next week (UPDATE: this is now available): “The Biggest Mistakes in Relationship Marketing” and “The 7 Golden Rules in Relationship Marketing.” Both will come with a POWERPoint version (including notes). The former is coming out on Tuesday (Dec. 1) and the latter on Thursday (Dec. 3) of next week. However, as a special thanks to those of you who are reading this and have supported me all along, I’d like to send you a copy of a white paper that combines both posts before anyone else gets it. I’ll send this out to you on Wednesday (Dec. 2), which means you’ll be the first to see “The 7 Golden Rules of Relationship Marketing” before it goes public. The combined white paper won’t be available for the public until at least December 9. It’s not a new car or anything, but it’s something…

If you’re interested, just fill out the form below (note: your email address will only be used to send this one white paper and not for any other purpose). This form generally does not work if you’re reading this on an email platform or some RSS readers. If you’re having trouble, click through to the post to use the form.

cforms contact form by delicious:days

Thanks again for your support so far and I hope I can continue to provide more valuable content to keep you coming back in the future.

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Okay, so my take…

As you know, I did have the privilege of speaking twice at this meeting (you can get copies of my presentations here), but I also got to listen to the 60+ other speakers. I had some preconceptions of what I’d hear at the meeting and many of these were right on, but I also was surprised by a few things and learned a few more. At the same time, I didn’t hear the answers to a few things that have been nagging me.

Today I’m speaking at a Business Development Institute conference about my experience. My talk title is: “Three Things I Learned at the FDA Social Media Hearings and Three I Wish I Had.”

Not the shortest title I’ve ever used, but it’s descriptive.

I won’t recap the entire presentation here, but see below for a link to download my presentation, which includes my speaking notes and see for yourself. For those of you who were/are at the conference today, thanks for stopping by.

In summary, here are the three things I learned:

• The FDA gets it
• MedWatch is dead (a serious AE, BTW)
• Consumers might actually want us there

And, the things I didn’t learn (but wish I had):

• FDA’s plan for keeping up
• The end of red herrings
• What pharma REALLY wants to do

As usual, my topic headlines don’t make much sense on there own, so I’d invite you to download a copy of my presentation and read along with the speaker’s notes for more detail. I’ll be writing about a few of these topics in future posts, so more detail will be forthcoming. In the meantime, for my initial thoughts on the FDA hearings, feel free to download a copy of my POWERPoint here:

Three Things I Learned at the FDA Social Media Hearings and Three I Wish I Had (1006 downloads)

I presented this at a recent BDI conference. I recorded my talk and matched it up to the slides via the magic at SlideShare. You can check it out below. Press the green play button to hear the audio. The slides will advance on their own or you can just click through at your leisure.

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So, study up before the hearing and see what people are doing now. One thing to keep in mind for all the conservative regulatory and legal folks out there: not a single program on this wiki (now over 250 industry examples alone) has ever gotten a warning letter. You heard that right. Not one.

Some highlights from this month’s update.

• A few more additions to Twitter from pharma including two from Bayer and one from BMS.
• Three new communities where patients can rate their doctors
• Two new MS communities. MS is still the disease with the largest number of examples on the wiki
• A very interesting concept from WiserTogether and their Wiser Pregnancy site allowing you to see the medical decisions and outcomes a large group of peers
• One more pharma company on Facebook, as AZ adds a Nexium page complete with commenting
• AZ also added a corporate blog AZ Health Connections, which is still one of only a handful of pharma blogs out there
• And finally, the very first use of Flickr I’ve seen from pharma. Not inspiring, but a good step.
• I’ve also added a bunch of “industry watcher” blogs and Twitter accounts. Check out if yours in on there now.

Pharma and Healthcare Social Media Wiki

If I sent you a note saying that you’d be included in the next update and you don’t see your listing, you’re in the queue for the next one.

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

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

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

Option 1

Copy and paste the code below onto your site:

<form><a href="http://www.doseofdigital.com/healthcare-pharma-social-media-wiki/" target="_blank"><img src="http://d2pa1q4iz3ea7o.cloudfront.net/wp-content/uploads/2009/08/doseofdigitalwikibadge1.jpg"/></a></form>

Option 2

Copy and paste the code below onto your site:

<form><a href="http://www.doseofdigital.com/healthcare-pharma-social-media-wiki/" target="_blank"><img src="http://d2pa1q4iz3ea7o.cloudfront.net/wp-content/uploads/2009/08/doseofdigitalwikibadge2.jpg"/></a></form>

Again, thank you all for your contributions. If you have any suggestions on how to improve the wiki, please let me know.

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