Adverse Event Reporting & Appropriate Dialogue in Social Media for Health Care
Jonathan Richman is a respected e-marketer and the author of Dose of Digital blog, in which he writes there is a Myth of Adverse Event Reporting in pharma marketing. Drawing upon a Nielsen Study which found that only 1 in 500 postings on the Yahoo Health discussion boards met the full criteria for adverse event reporting, pharma may in fact be over-sensitized to the issue.
Do AER staffing requirements prevent social media dialogue?
Assuming that the Nielsen study is statistically significant (is a sample size of 500 from Yahoo sufficient?) then what resources would be required to audit a message board with high volume traffic?
Example 1: ADHD Message Boards
ADHD Message Boards is a site devoted to the discussion of attention deficit and hyperactivity disorder. A particularly popular forum is Parents of ADHD Children with 105,938 posts as of July 2009. Applying the Nielsen metric of 1/500 would yield 211 reportable adverse events.
Assuming an AER auditor could review 2 messages a minute, auditing this board would require 882 person hours – or 110 person days – over the life of the board. This would be an almost full time job were it not for the fact that ADHD Message Boards do not feature personally identifiable information (curiously, the site lacks both a privacy policy and a terms of use statement) so any reporting obligations on this site would be obviated by lack of an identifiable patient and identifiable reporter.
What about social media sites with identifiable information?
Facebook, however, is a completely different story, with members’ identifiable information including a first and last name, an email address, and often a phone number on the user’s “info” tab.
Example 2: ADHD Moms on Facebook
As of July 2009, McNeil Pediatric’s ADHD Moms page on Facebook counted 8,505 members. Assuming 1 post per member multiplied by the “Nielsen coefficient” would yield a possible 17 adverse events, requiring 70 person hours – or 8.8 person days – of monitoring. Of course not every member would post, and some members would post more than once, so these estimates are just back of the envelope calculations. This scenario is staffable.
It’s a matter of appropriate dialogue
Richman’s blog post suggests that “adverse events are nothing more than negative reviews” and compares them to reviews for computer products.
For example, someone ranks a product 1-star and says “this didn’t work on my Mac.” Well, if you have a PC, you aren’t worried. Simple example, but you see how it works.
I would agree with him, but only up to a certain point. When making a purchasing decision for a discretionary product, I am willing to accept that “Dave from Des Moines” or “Sally from San Diego” might be qualified to review a new piece of software or a computer peripheral.
But are they qualified to provide accurate information about prescription drugs beyond their own experience? Unless they are willing to also share their age, weight, lifestyle, diet and exercise regime, medical history and enumerate any other medications they are also taking, I say “no.” There are too many confounding variables for me to believe there would be much, if any objectivity.
Social media is merely an extension of direct to consumer advertising
Television viewership is down. Newspaper and magazine readership is down. Follow the eyeballs and you end up on the Internet. DTC spending was down 18% last year. Follow the money and you find a lot of people scrambling to recapture a portion of that DTC spend by reallocating budget to social media. There’s some great work out there done by stellar agencies, but…
- Do you really want to hear tweets from a race car driver about Rx drugs?
- Do you really want to hear one mother’s opinion about an ADHD drug without the back story that her kid drinks 3 sugary colas and eats 2 candy bars a day?
- Or wouldn’t you prefer to learn about your insulin from video featuring method of action and patient testimonials?
Social media is merely a platform, not an ends onto itself. So while Richman may be on to something with his “myth of adverse event reporting” the real question remains:
What evidence is there that patients want a dialogue with a pharmaceutical company given their lack of trust in the industry at large?
Listening without engaging may not be glamorous. It may not recapture the entire DTC spend. But given the recession, $80 Billion in concessions to the federal government, and the need to maintain a low profile until health care reform legislation is hammered out, what’s wrong with using social media as a distribution platform and skipping the public dialogue altogether?
Jonathan Richman
Jonathan (Dose of Digital) here…
Great article. You make some excellent points regarding my post. I hadn’t thought of doing the math on how many reportable adverse events a given site might generate. I’m not sure I totally agree with the staffing requirements. Keep in mind that the boards in your examples have been around for at least a few years meaning that, in the first case, it’s 880 hours spread out over 5 years (ADHD forum started in 2004). That’s 176 hours per year or about 3-4 hours a week…far from a full-time job.
You’re totally right about the recommendations and which SHOULD carry more weight. People do put a lot of stock in reviews of discretionary product (there are many studies about this), but I don’t know of any data that suggests the same level of trust in medical reviews (or lack of trust). They clearly aren’t the same: a computer accessory and your health.
Having said that, look at any healthcare message boards and find a message where someone is asking for advice. Follow the thread all the way through and you might be surprised to see how willing people are to accept advice from a stranger. That might be a board on a site like WebMD. However, when you go to a site like Patients Like Me where there is far more transparency to the point that people use their real names, pictures, and complete medical history in many cases. When someone is willing to provide this to you, I would almost guarantee that people would be very open to their advice. This is why Patients Like Me, in my opinion, is the best in class model of how patient communities should work. Everything else is still just a glorified user group going back to the birth of the Internet.
PS: I totally agree with you on the Twitter issue. Let’s forget about Twitter for branded pharma marketing at this point. There are far more important e-marketing channels we need to get right before going to Twitter. And for the record, I’m getting a little tired of all the talk of social media and how it’s a perfect channel for pharma. It’s the hot thing to talk about, but there’s a lot of other areas pharma needs to get right before trying to spend money in social media. How about getting their search marketing right so that pharma brand sites actually show up in the first 1000 (much less top three) results for important keywords. That would have a much bigger short and long term impact compared to social media and you can do it today. No regulatory issues, no FDA guidelines required.
Thanks and keep up the good work.
Jonathan
Mark Hollander
Good points about actual person hours. It might be higher than 3-4, as I just chose one child board “Parents of ADHD Children” and there are 20 more with varying degrees of activity. (Who knew there would be an Irish ADHD Forum?)
What advice would you offer pharma about SEO they are competing against internet pharmacies and others who are looking to hijack the brand name? For example, here’s a quick spider simulation of the home page of Viagra.com, which is well optimized.
http://www.scribd.com/doc/17237223/Spider-Simulation-Viagra
Jonathan Richman
Yes, there are 20 (probably more) boards out there for any given disease, but remember that pharma companies aren’t responsible for reporting the AEs that are recorded on any site they don’t own or control. In other words, if it’s not reported directly to them, they are not required to report it formally to the FDA. Monitoring these sites to see what people are saying and responding in certain cases is a different story all together. You need a bunch of dedicated people for this.
I’m talking about a situation where a pharma brand might want their own social network on a branded or unbranded site (not sure I think they do, but hypothetically). In this case, there’d be 1 in 500 posts that would require some action. Automated tools could scan for keywords and make the workload a lot less by triaging posts suspected of containing an AE report. In this case, there’s only one board to manage.
As far SEO goes, I’m not sure I understand your question and example. No one has hijacked “viagra.” When you search for it in Google, the first listing is Viagra.com. I’m not so much worried about the brand name either. I believe that if someone is searching for your brand name, it might be too late to influence them anyway. Clearly, they have a solution in mind. I’m more concerned about cases where people are seeking a solution to a problem. Here’s my full post on this issue: http://bit.ly/osTBG. However, in short, there’s no reason why Lipitor should be the 63rd search result for “high cholesterol” or not even rank for “heart health.” “Heart health” is one of their site meta keywords, so they must think it’s important if they bothered coding it and yet it doesn’t show up in the first 500 listings on Google. Plavix.com is the 122nd result for “clots.” Advair.com is the 198th listing for “asthma.” I could go on and on. These sites might not every make it to the number one listing, but the front page isn’t asking too much. Many of these companies aren’t using basic SEO best practices. So before concentrating in other areas, let’s fix what’s fixable and proven effective.
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