Pharma and Twitter: a happy marriage or time for a divorce?

pharmafile | September 22, 2014 | Feature | Manufacturing and Production, Medical Communications, Research and Development, Sales and Marketing |  Facebook, PMCPA, Twitter, digital, pharma, social media 

There has been a phenomenal rise in the use and scale of social media over the past decade, from the early days of clunky MySpace pages to the advent of Facebook, Pinterest and Twitter. 

These platforms have expanded inexorably as the hardware to carry them – from smartphones and tablets to new wearable tech – has grown alongside.

This in turn has brought a new age of online sociality where thousands of people can interact with you no matter where you are and instantly share everything from news and views to images, and even your location.

Although initially designed around friends and family use, global multinational corporations have been quick to jump on the social media bandwagon by compiling marketing teams made-up of young graduates with an innate understanding of how to utilise the platforms effectively.

Pharma has been arriving slower to the table than most other industries however, given the strict regulations it must adhere to around the world – especially in Europe – which bars pharma talking to patients about prescription medicines.

But this has not stopped some within the industry from pursuing a new digital strategy based on social media, and Twitter appears to be the platform of choice for their communication departments.

This micro-blogging site, which only allows 140 characters per tweet, was established in 2006 and has quickly become the site of choice for celebrities and increasingly for corporations, including pharma.

German-based private firm Boehringer Ingelheim was one of the first big pharma companies to join the medium back in 2007 when Twitter was just getting started, with its main US account now boasting nearly 38,000 followers. But those firms looking to be pioneers of the medium have found themselves left in the dark over what it can, and cannot say.

There is European legislation of direct-to-consumer advertising (DTC) and its restraints, but this is not bespoke for sites such as Twitter, and some companies – including Bayer in 2011 and Medivir last year – have seen themselves reprimanded for breaking certain regulations when using the site.

In the UK, any real form of digital guidance seems to be lacking, with only a basic set of rules in line with European legislation currently available.

It would appear that no formal industry bodies want to take responsibility for this area, and in an interview with Pharmafile earlier this year the ABPI’s new president Jonathan Emms says that it is difficult to create such rules, as new media such as Twitter and Facebook can be replaced with new sites that would require an entirely new set of rules, making it difficult to keep up.

The ABPI has also told Pharmafile that it is considering whether or not it should take responsibility for digital rules at all, given the cumbersome nature of producing guidance. It acknowledges, however, that this is an important area for pharma in terms of communication.

Its last president before Emms, Merck’s Deepak Khanna, told Pharmafile in his final interview in April that: “To be honest, [creating digital guidance] wasn’t much of my focus during my presidency.

“I think it is important in regards to how we approach communications with healthcare providers and how we balance this with a fair balance, and it’s complicated because there are some companies that are much more proactive with social media, and there are some that aren’t. But it just wasn’t an area of focus for me.” This neatly sums up the regulatory malaise inherent in the UK.

The PMCPA, which polices and advises on the ABPI’s Code of Conduct, has in recent years put together an ‘informal guidance’ on digital communications – with the latest update to this being published in February this year.

But this is not a set of clear, binding rules of the sort that pharma is looking for. It is instead a short document that essentially points pharma towards certain clauses in the Code, and how they can be interpreted in certain circumstances online. This is true too with the European lobby group EFPIA, which also has digital guidance that is simply parallel to European regulations.

Many pharma companies have complained to Pharmafile off-the-record that this simply isn’t good enough, given the uniquely regulated way the industry is run, and many are desperate for updated rules around online engagement.

This does not appear to be forthcoming however given the comments from the ABPI, and so the industry remains frustrated by a lack of coherent, UK and European-wide advice and rules on Twitter, and indeed other social media platforms.

FDA guidance: good start, but more needed

You might think that across the pond things would be easier. But even though DTC is allowed in the US, this does not mean that pharma has a free pass to say what it likes online.

Over the last two years, two companies have found themselves in the sights of the FDA after it warned them for violating federal advertising regulations by ‘liking’ unapproved claims on the social networking website Facebook.

But while FDA’s warnings have yet to set off a wider crackdown on pharma companies, recent changes to Twitter have raised the possibility that similar attention might soon be focussed there.

The FDA has so far issued 11 ‘Warning Letters’ regarding the improper use of Twitter to promote products, although none have yet mentioned the use of a Twitter feature similar to Facebook’s ‘like’ button, known as a ‘favourite’.

This feature has been around for a number of years now and is essentially used to bookmark certain tweets. But within the last few months, Twitter has rolled out a new aesthetic design that allows users to see what their friends are ‘favouriting’ more easily than ever.

So as the FDA can chide a company for ‘liking’ a post, it may soon be doing the same for those ‘favouriting’ a post that falls foul of its Bad Ad programme as well, especially now as favourite tweets are prominently displayed on a user’s profile.

Whether this will happen remains – like much of the guidance on digital – unclear. The FDA has been just as slow as the ABPI and EFPIA in updating its digital guidance in line with the times, with only a drip-feed of fairly ‘soft’ rules approaching over the past five years.

But in June there was something of a breakthrough, when the FDA issued new draft guidance on how pharma and medical device firms in the US can talk about their products on social media sites.

The new proposal would in a nutshell mean that companies have to post both the benefits and the main risks associated with a product – with a hyperlink directing the reader to a more detailed list.

As an example the FDA used a fictional memory loss drug called ‘NoFocus’, saying an acceptable tweet about this drug could read: “NoFocus for mild to moderate memory loss; may cause seizures in patients with a seizure disorder www.nofocus.com/risk”. This means the firm tweeting about the drug would have to put in its full indication – it could not just say it was for memory loss, as this could be misleading.

For some products however, the limited space on media such as Twitter’s 140-character rule may prove more difficult.

This is especially true with prescription medicines that come with complex indications or extensive serious risks, as many treatments now have. The FDA says that “character space limitations imposed by platform providers [such as Twitter] may not enable meaningful presentations of both benefit and risk”.

But it does say that simple ‘reminder promotions’, in which only the name of the product is displayed, would be allowed, as long as an initial posting did discuss its indication and safety profile.

This is a helpful addition to pharma – but one that is not set in stone, with the FDA declaring this guidance as its current ‘thinking’ on the issue, rather than a hard and fast rule.

Pharma questions digital in Europe

But whilst companies such as Boehringer have signed up to these new media whole-heartedly, other pharma firms have intentionally sat back, and are not convinced of how their strategies align with the new digital landscape.

Johanna Mercier, general manager of Bristol-Myers Squibb (BMS) in the UK and Ireland, tells Pharmafile that she is not sure about the return on investment for her company – in the EU at least – for using social media.

Mercier, a Canadian who has worked for BMS there, in the US and in Europe, says: “My opinion stems from my last role [working for BMS in Europe]. So BMS as a company has Twitter feeds, Facebook and so on, so there is certainly digital activity.

“But in light of the regulations [barring DTC advertising in the EU], this means that we are very careful, because the guidance around social media is not crystal clear to say the least, and I’m not always sure about the return on it.”

She goes on: “As we all know, these feeds definitely aren’t going straight to patients. But I think if you were talking to me in the US, that’d be a different thing, and we are doing a lot of social media in the US as there are very different regulations there.

“But even there we have to be very careful because if there is a side effect that comes through to us via social media then it has to be reported, and you have to find a way of doing that in the right way. People like the anonymity but at the same time, the companies out there don’t because they are responsible for reporting this information.”

Mercier explains that by using platforms such as Twitter, companies are opening themselves up to potentially millions of people, ‘and that’s a big job’. She says: “For me, the role in the UK is more of a ‘listening role’ to social media. “It’s more about being aware of what’s going on because you can get a lot of insights out of that.”

There is always a feeling that there is a small committee behind every corporate tweeter in pharma who can in no way contravene any rules – and that destroys instantly any sense of a two-way, or organic, conversation.

When this is put to Mercier she admits she has this feeling too, and that it simply stunts any sort of natural engagement online. There is also a large question as to what the return on investment from paying a comms team to run a corporate Twitter account actually would be.

Ultimately, pharma’s goal is always to increase awareness of its products or the diseases it caters for, in order to increase the number of prescription medicines sold around the world.

It will not put itself at risk of receiving hefty fines – and a public berating on platforms like Twitter – just to talk to a few patients. In the US, as Mercier explains, it’s clear that pharma wants to be involved in social media as they can talk about their medicines.

But in the European Union the reasons are far less clear and a return on investment uncertain, as Mercier concludes: “I don’t even know how you’d connect the dots on finding out how running a Twitter account helped the company.”

A patient’s view of pharma on Twitter

Michael Seres, a British Crohn’s disease patient who creates social media programmes and online patient communities, tells Pharmafile that he has mixed views on whether pharma is doing the best for patients online.

He says that the industry appears to use Twitter as “a communications vehicle, as opposed to an engagement tool”.

He goes on: “For pharma, it is about telling the world about what they do, as opposed to asking questions and responding to feedback. Although saying that, I do sense a slow shift towards engagement, but historically that has not been there.”

He says that pharma as a whole understands that becoming more patient-centric is ‘vital to their future’, adding that Twitter is an ‘ideal platform’ to start this process.

“From my own perspective, pharma has been slow to react to a changing healthcare market; it is only now, after being a patient for over 30 years that I am starting to engage directly with pharma. And it is Twitter that enables me to build that relationship.”

Seres says he uses Twitter “as an important part of my toolkit when managing my health”. As with an increasing level of younger and chronic patients, he also uses it regularly for information, to post questions and engage in debate and discussion with other users, patients and companies.

So-called ‘Tweetchats’ form a vital part of that, Seres says. He points to his weekly chats such as #nhssm which “provide the perfect platform for patients to engage with all aspects of the healthcare system.

“However, perhaps the biggest reason I use Twitter is to help and support patients living with similar conditions to myself. Twitter allows conversations to happen between patients who otherwise would never meet. We share hints and tips, techniques for administering medicine and even share experiences such as side effect of medications.”

When asked if Twitter is a better platform for patients than other social media, he says that it is simply a different platform and that they all have their place. But he believes that Twitter is a ‘great place to start’ because your engagement is immediate, and you can decide when to dip in and out of a conversation.

The difficulty however, is that it can be overwhelming due to the volume of tweets, Seres explains.

“But you soon learn who your trusted sources are and who you learn from. Twitter has enabled me to have conversations with people who would ordinarily never take my phone call or respond to my emails. It democratises the voice.”

Harnessing social media 

But other platforms also have much to offer. Seres says: “I find that Facebook is a wonderful forum for online community support. It is a more social environment to discuss things and it is a great support tool for patients. Pharma could really learn a lot from ‘listening’ to the conversations that go on between patients on Facebook.”

For Seres, YouTube is also a ‘wonderful patient resource’. He says: “I have learnt so much from patients on YouTube. If you want to know the easiest way to inject yourself, do an A-sceptic technique or clean a wound etc., then patient videos on YouTube are incredibly helpful. I would urge pharma and the wider medical community to watch the patient videos. There is so much shared learning online.”

When asked if pharma is good enough at using new digital media like Twitter, he says: “In short the answer to the first part of the questions is ‘no’ and the second part is ‘yes’ – however, I respect that there are reasons for this being the case.

“Regulatory constraints make it difficult and historically pharma have not needed to use digital media, [but] times have changed and technology has moved on. I always believe that it takes a brave and bold person, or company, to come online and engage in social media especially when it is not a platform they’ve used before.

“It is much easier to say no, but in the current climate that is not good enough. Pharma needs to move from using digital media to distribute a message to using it as a learning tool and engagement platform. This requires the shackles to come off and to not stand behind the NO, but find ways of saying yes.”

Seres concludes that the “future of healthcare is digital technology”. He says: “The gap between those using it and those who can’t or choose not to is now shrinking. I am not suggesting that it is the be all and end all but it cannot be ignored. As I hear more and more that pharma’s business model is changing and patients are firmly in the centre then social media will play an even more prominent role.”

Editor’s conclusion

Social media platforms sit upon ever-shifting sands (the rise and fall of Bebo, MySpace and MSN Messaging are testament to that), and it is impossible for regulators always to be proactive towards the new and evolving digital landscape, as it would require them to produce new guidance once a particular platform has taken hold – and is indeed shown to be a long-term offering rather than a flash in the pan – otherwise creating new guidance for things like MySpace corporate pages would be a waste of time.

But Facebook and Twitter are multi-billion dollar earning entities with nearly a decade of high use and user growth behind each of them, so in the last five or six years new bespoke rules could have been drawn up by regulators such as the FDA and EMA, or pharma groups such as the ABPI or EFPIA – but this simply hasn’t happened.

As Seres says he respects the ‘bold’ decision of any company – especially a pharma firm – to interact on Twitter because it is a major risk. Many are still holding back seemingly unsure of the ROI, as this too is still a major sticking point and a valid one for businesses assessing their strategies.

So can Twitter and pharma co-exist in marital bliss? I doubt it, but as with any marriage: communication, engagement and listening are key. Divorce is simply not an option in this increasingly digital world.