Liking Social Pharma

Pharma has been slow off the mark when it comes to social media. Only half of the top 50 global pharmaceutical companies use Facebook, Twitter or YouTube – and only ten use all three, according to a 2014 report from IMS Health (1). A survey from the Digital Health Coalition (DHC) and Google agrees, with nearly two thirds of respondents (DHC members) claiming that the pharmaceutical and medical device industry is lagging behind other sectors (2).

Despite the slow start, a number of social media campaigns are generating genuine interest and engagement from patients. Such campaigns are the result of focused strategies that step away from the use of singular, one-way channels to disseminate press releases, and they prove that some companies are starting to take social media much more seriously.

James Musick, head of digital communications and social media at Novartis, says, “Most companies are now on the cusp of realizing a more structured strategy where they are more deliberate about the areas they want to be active in.” Previously, individual staff members or departments might engage in a particular channel that suited a particular need; “For example, human resources may have decided to use LinkedIn for recruitment because someone in the department thought it was a good idea,” he adds.

However, as knowledge of the platforms – and how to use them effectively – grows, so too does the industry’s understanding of the potential benefits. For those unfamiliar with the advantages, the IMS Health report nicely groups the use of social media into three core areas:

• Gathering information about attitudes, actions and behaviors of consumers.
  
• Broadcasting messages.
  
• Engaging people on healthcare-related topics and stimulating public discussions.

In addition, regulators see potential for social media in terms of pharmacovigilance and the identification of regional quality issues through geomapping.

Still unconvinced? “The benefits for pharma are significant,” explains Stacey Bernstein, senior vice president and director of digital health at the public relations firm, Weber Shandwick. “The reality is that social media is where people get their health information, where they engage with brands and companies, and where they share their health experiences with one another.

For a pharma company that wants to be patient-centric in today’s social world, you have to be in social media. It’s an opportunity to break down the big, bad pharma persona and to show a more human side.”

And yet, many remain wary. What about regulatory backlash? How exactly do you keep a firm grasp on platforms that are constantly evolving? How do you accurately measure the benefits and return on investment? And how do you handle reports of adverse drug reactions (ADRs) or Individual Case Safety Reports (ICSRs)  on your social media channels… ?

As the questions mount, any degree of trepidation starts to make sense. Here, we explore some of the biggest fears – and how you can overcome them.

Common sense update

The regulatory environment is clearly a challenge. A number of Warning Letters have been issued to companies regarding their use of social media (3-7). For international pharma companies, there is also the headache associated with operating across different regulatory environments, where ‘offline’ guidance may vary significantly.

At present, the only specific social media guidance for promoting medicines is from the FDA – and it’s only a draft. The guidance comprises two documents that were released in June 2014: “Internet/Social Media Platforms with Character Space Limitations –Presenting Risk and Benefit Information for Prescription Drugs and Medical Devices”; and “Internet/Social Media Platforms: Correcting Independent Third-Party Misinformation About Prescription Drugs and Medical Devices” (8, 9). The documents have already ignited much discussion (mainly critical) and the comment period for both was reopened for 30 days at the end of September.

The FDA actually held a public hearing about social media and medicinal products back in November 2009 – the length of time it has taken to produce the guidance documents is testimony to the difficulty in tackling such a nebulous topic. “People expected guidance within the year, but it’s taken five,” says Bernstein, “but imagine what would have happened if they had issued guidance back in 2009; they’d be completely out of date because of the high velocity at which social media changes.”

“The FDA is in the same difficult spot that the rest of us are,” adds Musick. “Social media channels change extraordinarily quickly and the FDA is trying to create something, structured and futureproof, which is the right thing to do, but of course they have hundreds of critics. While some of the feedback may be fair, the big picture is that they are trying to give guidance that recognizes that social media is useful and fit for consumers and patients, and to provide signposts that tell us how to use it responsibly. They have the best interests of consumers and patients at heart.”

It is possible to be highly successful on social media without stepping on the toes of regulators (see box, “Like”). After all, pharma companies are well used to working within tight regulatory guidelines. “We know how to be compliant,” says Musick. “There may be a few fuzzy edges where we have to talk to a regulator, but we know what the intent is; to put forward fair and balanced information. The big question is how to overcome the hurdles; for example, the 140 characters on Twitter.”

Bernstein believes good judgment is key: “There may not be guidelines for social media, but there is common sense. A lot of regulatory bodies say you should follow the offline guidance; whatever you do offline you should do online too. You’ll often see that the missteps companies have made in social media would probably have resulted in the same regulatory consequences if they had happened offline too. It’s not usually the social channel that’s the problem but the content.”

Companies can also take heart from the fact that the FDA and EMA are no strangers to social media, using Twitter, Facebook and YouTube; in fact, if the FDA was assessed alongside pharma companies on the IMS Health report rankings, they would sit in the top 3 (1).

ADR alert

Another prime concern surrounds the obligation to report all known ADRs; it’s not necessary to monitor every blog and social media post in the world, of course, but you do have to monitor social media accounts that you control. It’s an extra layer of work that some would prefer not to take on, but Daniel Ghinn, CEO of healthcare engagement consultancy Creation Healthcare argues that it’s not as tricky as companies may expect. “There is the idea that a company’s pharmacovigilance team might be inundated with reportable events, but in practice this is rarely the case, although it varies on the therapy area, drug and market,” he says. “A practical way that some of our clients manage this risk is to agree a threshold when launching a campaign or initiative: if an agreed limit of reportable events are discovered, then the initiative is paused pending a review. This limit might be set at say 5 or 10 reportable events and in my experience has never been reached.”

In fact, rather than being worried about ADRs, some companies are exploring data mining as an information-gathering exercise. “For monitoring social media for ADRs and reportable ICSRs, at the moment action varies,” says Mick Foy, Group Manager, Vigilance, Intelligence & Research group at the UK’s Medicines and Healthcare products regulatory Agency (MHRA). “EU Regulations say that if you see something when mining that meets the criteria of a valid case you need to report it. Some innovative companies have gone beyond this and are using it from a marketing perspective to see what people say about their products, or to actively look for new pharmacovigilance signals, whereas others are concerned about compliance with the regulations and not much more, so tend not to look.”

Ghinn adds, “We have some clients who would actually like to deliberately look for events like off-label use, or product complains, in order to learn more about their customers and perhaps identify new indications for their products. It’s an exciting area, but not for the faint-hearted, as searching for adverse events or conversations about off-label use is a minefield to many in the industry!”

The potential for digital and social media in pharmacovigilance was recognized by Europe’s Innovative Medicines Initiative (IMI), which put out a call in 2013 for proposals to leverage technologies to introduce a mobile app for reporting ADRs and a platform for mining social media data. The IMI call generated a lot of interest, with around 19 bids put forward, but the final project was awarded to a consortium organized by the MHRA.

For the project – now called WEB-RADR (Recognizing Adverse Drug Reactions) – the consortium is developing a mobile app, which could be introduced in the UK and Croatia in the next six months and examining technologies for social media mining, as well as looking to develop a policy framework (10).

“Developing the mobile app is very clear-cut, in so much as it will be used for the reporting of ICSRs and accessing medicines information,” says Foy, “but the social media side is more difficult. We also need to consider the ethics. At this stage I’m not a fan of using individual posts or tweets as a basis for identifying ISCRs, but we would have the ability to respond to tweets or posts and say, ‘It looks like you have experienced an adverse drug reaction. Would you like to report it?’ But is this an intrusion? Will the poster/blogger/tweeter be expecting or welcoming a response out of the blue from MHRA? We’ll be seeking opinions from legal and ethical experts on that matter.”

Foy also sees great potential for social media in other aspects. One area he is really interested in – and which the consortium will be looking at – is geomapping where public tweets and Facebook posts raising issues have occurred. Potentially, this could identify batch issues, counterfeits and isolated defects in regions where there appears to be an increase in quality-type events.

“It could lead us to investigate batches and even medication errors; perhaps there are bad practices in certain regions, for instance,” he explains.

Follow me!

Once you’ve got to grips with what you need to do from a regulatory and ADR standpoint, internal buy-in and a clear strategy is essential to recognize the value of social media. Both Bernstein and Musick believe that the biggest barriers to implementing social media actually lie within the company itself. Musick points to the Gartner Hype cycle. “This cycle is so accurate that it’s funny – whether it’s talking about social media or anything else! People see an opportunity and put in the early effort, but then – especially in a big company – people start asking you to quantify results, which is difficult in an emerging space. You then have the period of disillusionment and attention may wane, but then as you push through that and learn more about the platform, you steadily see progress.”

Companies who have been present on social media since the early days have been steadily growing their Twitter and Facebook audiences for many years, which gives them a big advantage – and larger reach – than those just starting out. With so many companies now boasting large social media accounts, there is a danger that new starters might expect it to be easy. But the reality is that successful social media strategies require significant changes to operations. Musick warns that the structure of communications departments can also be an issue. “Historically, communications departments were structured around traditional one-to-many communication methods, whereas social media tends to be about engagement and dialogue, which is more one-to-one and requires a different set of skills. It’s a daunting task and it’s also not easy to find social media experts,” he explains. “For companies that started using social media early on, no matter how disparate, you’ll usually find that they have internal champions, who can stand up and say that even though social media is difficult to fully harness, it’s the future of communications – so you need to do it.”
For Bernstein, the biggest issue internally is lack of digital confidence. “There can be a lot of fear, anxiety and uncertainty about what you’re doing and whether it’s right. Before you jump into launching a social or digital program, you really need to figure out your internal guidelines and educate people internally about what they can or can’t do, as well as the benefits.”

Indeed, many companies, including AstraZeneca, Roche and Novartis, have published their own internal guidelines for social media, detailing what behaviour is expected from their employees. “I think rolling out concise, clear guidelines, which are easy to read rather than being full of legal language, is a very important milestone in a social media strategy because it can quell employee misconceptions,” says Musick. “People have many different feelings about social media and what they should and shouldn’t do, so it’s important to establish a framework. Rolling out guidelines at a big company isn’t easy, but it sparks a lot of positive social media activity.”

“At Novo Nordisk, we have also developed extensive guidelines about social media,” adds Benedikte Larsen, team leader in corporate branding at Novo Nordisk. “We have decided that we don’t communicate about products on our social media platforms - though there are a few exceptions in US.”

Channel choice

As well as developing guidelines, you also need to decide what channels to focus on. Twitter? Facebook? LinkedIn? Pinterest? What about Flipboard or Xing?  The number and variety of platforms can seem overwhelming, but it’s best to avoid a scattergun approach. Musick advises picking a set number of channels with a ‘quality over quantity’ mindset. “Look at the strengths and weaknesses of each channel,” he says.

“You don’t just grab a piece of content or a topic that you want to talk about and throw it out in all the channels, which is the old way of doing it. You should consider what you want to talk about, and then look at which channels are connected to the audience for this topic. You then need to develop the content in a way that works for the channel.”

Larsen also emphasizes a carefully considered approach. “We launched our first platforms in early 2009 – an internal video sharing platform and an external graduate blog. The strategy was to start small, learn as we go and only with platforms where we could see a clear business value. The strategy has evolved in the sense that we now have more platforms: Facebook, Twitter (several accounts, focusing on different topics and target audiences), Google+, Pinterest, LinkedIn, Instagram, Flickr and YouTube. All platforms have been launched one by one.”

Bernstein adds, “You need to give people content that they actually want to read. There are still so many companies out there pumping out content that just sounds like a press release. It’s obviously not been written for social media.”

Snapshot of success

The successes of social media can be difficult to measure and quantify, so it’s challenging to single out specific companies or campaigns, but there are a few companies who are generally agreed to be ahead of the pack. The IMS Health report ranked Johnson & Johnson as the top performer in terms of reach (number of listeners, likes, shares, and so on), relevance and relationship. J&J’s news account @JNJNews has over 75,000 followers on Twitter and the company’s Facebook page has attracted over 645,500 likes. That’s streets ahead of the competition; 12,000 more Twitter followers and over 500,000 more ‘likes’ than GlaxoSmithKline, who took the runner-up spot in the report. Other top performers included Novo Nordisk, Pfizer and Novartis. In September, Novartis was ranked as the Digital Pharma Company of the Year in the UK at the PM Society for Digital Media Awards (11). At the same event, Novo Nordisk took home an award for digital pioneer, which was awarded to Adam Boucher, who played a key role in the company’s ‘Decisions in Time’ series.

Another company regularly singled out by digital consultants and online bloggers is Boehringer Ingelheim, which has won praise for its informal style. Their live tweetchats and Facebook game Syrum have really got the industry talking. We’ve listed three high-impact social media campaigns in the sidebar, “Like”.

And what about the future of social media? Only time will tell. “I don’t think anyone can say with any degree of certainty what the future of social media and digital technology will look like because technology changes so much,” says Foy. “Phones have more power than main frames had 10 years ago! People are definitely using social media more and more – and in the future we’ll see more platforms, some more serious than others. A couple of years ago, no one had heard of Instagram or Snapchat and look where they are now. In years, they could be gone and something else could be around the corner… As for how we’ll use them, hopefully projects like WEB-RADR will help to inform us.”