A discussion: Pharmaceutical Marketing and the New Social Media by Jeremy Greene and Aaron Kesselheim

In 2010, an article entitled "Pharmaceutical Marketing and the New Social Media", written by Jeremy Greene and Aaron Kesselheim, appeared in the New England Journal of Medicine (Vol. 363, No. 22, pp. 2087-2089). The article looks at social media’s role (or lack of) within the pharmaceutical industry and the pharma organisation’s marketing initiatives and will be the focus of this post.

The article’s key theme is that, even if global usage of social media (notably Facebook and Twitter) has skyrocketed, with surveys indicating that 60% of Americans turn first to the internet when seeking health-related information, pharmaceutical organisations are still slow to adopt such channels. This said, the authors present legitimate challenges for such organisations.

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The authors note that “the drug industry allocated less than 4% of the more than $4 billion it spent on direct-to-consumer advertising to internet outlets in 2008, and only a tiny fraction of that was for social networking sites.” But this stat does not tell the full story, certainly now almost 10 years on from when the article was published.

Nonetheless, this post will look at some of the conclusions and discussions from the article as much of the challenges social media, and direct-to-consumer advertising on the internet creates are still relevant today.

A WAITING GAME

Greene and Kesselheim correctly state that as communications media evolves, organisations have waited for the FDA before making a move to the new platforms. This does account for the pharmaceutical industry’s slow adoption of new channels and new avenues for marketing communication in general.

They also note how the FDA has revised their guidance on advertising prescription drugs, notably in 1985, 1997 and 1999, permitting broadcast media to include websites and digital channels, marketing and advertising spend has increased from $579 million in 1996 to $1.3 billion in 1998 and to over $4 billion in 2008, all of which, revisions which took a significant period of time to happen. It is therefore plausible that it wouldn't be for some time before social media itself would be considered a viable marketing channel.

LACK OF CONTROL, AND CONCERN FOR EFFECTIVENESS

During this time, Twitter and Facebook emerged into the mainstream for personal and business. As pharmaceutical organisations experimented with these channels, the FDA highlighted growing concern about the effectiveness of advertising on those channels and whether increased access to risk information (side effects) does not necessarily translate into a realistic presentation of risks associated with those products advertised.

The authors identify social media’s ability for two-way dialogue, as opposed to pharma’s traditional one-way approach, where organisations can lose control of the content of the promotional message. However, nine years on since the article was published, the two-way conversation that social media produces is no longer considered a problem, where transparency and engagement with audiences is not just commonplace, it is encouraged by the organisations themselves.

EARLY SOCIAL MEDIA CHALLENGES FOR PHARMA & HEALTHCARE

On this subject, the authors attempt to predict (now which we know is inaccurate) that the FDA may try to ban pharmaceutical promotion entirely from these media or, in the case of the FDA issuing new guidance, “there will probably be an explosion of marketing in online social media, as there was in print media in the 1980s and broadcast media in the 1990s”, now more accurate. We know that an explosion as such failed to materialise, but pharma organisations (more so big pharma) have slowly adopted social media to some extent. The reasons for this may be the challenges (see more at pharmaceutical marketing challenges) organisations face, as the authors state:

1. “First, there is a dearth of research on the clinical and public health impact of communication about drugs… [and]… as medical messages on social media become increasingly available to patients, clinicians will need to better understand the impact of these media, especially in terms of product promotion.” So as the patients themselves become more informed of pharmaceutical products via social media, a divide between those patients and the clinicians may appear and the clinicians will also be forced to adopt social media practices, with social media potentially undermining the profession.

2. “Second, it is crucial to address the problem of disclosure of financial interests in social media. Although most internet users can often (but not always) find data on drugs’ risks and benefits within a few keystrokes, it is hard to determine whether the source is credible and disinterested.” Social media by its very nature is a micro-messaging and blogging platform, better designed for short public relations-led messaging rather than to inform users of what is generally technical and detailed information about products in an industry that is governed to do just that. Which begs the question: Is social media at all suited to the pharmaceutical industry?

3. "Third, physicians and consumers should hold the FDA and pharmaceutical manufacturers responsible for maintaining credible information in social media regarding the benefits and risks of therapeutic products." The authors, however, identify the lack of resources on behalf of the FDA meaning that is would be down to the organisations themselves to monitor online discussions about their products. Of course, positive word of mouth on these platforms can be hugely beneficial for a pharmaceutical organisation and can include customer reviews and personal testimonials.

But a major concern still is to ensure that truthful information about risks and benefits is conveyed to patients, and not fake and contributions by the organisations themselves, masked as users of the products. Manufacturers can unethically (see more at pharmaceutical marketing ethics) support third-party bloggers, posters and Twitter users who make flattering claims and discredit negative claims about their products in online discussions.

Social media within the pharmaceutical industry is a unique beast. Social platforms can provide a hugely influential channel for organisations looking to share information and engage in discussions with audiences. Given the nature of healthcare products in big pharma, and even deeper within the pharmaceutical supply chain, social media presents a warning light. This warning light first shined in 2010 when Greene and Kesselheim, amongst others, first wrote this article and presented some early challenges, which have since escalated to new levels.

AN ADDED RESPONSIBILITY FOR ORGANISATIONS

In 2006, Kalman Applbaum published his essay entitled Pharmaceutical Marketing and the invention of the Medical Consumer which also highlights the potential for consumers to be exposed to more pharmaceutical advertising on the internet and social media which could result in negative impacts on patient interactions within the healthcare system, essentially turning them into "consumers" unless the regulators step in.

“Given the potentially important health implications of drug promotion in these media, regulators and manufacturers will have to share the responsibility for oversight.” The organisations need to become more ethically responsible and not wait for the regulators to provide guidance, who themselves, are required to become more proactive in understanding the challenges that social media marketing creates to promote pharmaceutical products: "...manufacturers have tended to wait for [regulatory authorities] to establish explicit codes of acceptable marketing practices before devoting substantial resources to a new medium.“

Pharmaceutical Marketing and the New Social Media (2010) by Jeremy Greene and Aaron Kesselheim can be accessed here.