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Pharma, digital and patients: a healthy concoction?

Published on 09/06/14 at 08:38am
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A young woman sits stunned in an oncologist’s office, unsure of where to look or how to react to the terrible news. The doctor is telling her that she has cancer – meaning the woman is no longer the same person she was when she walked into the office, as for now she has become a ‘patient’.

And as a patient, she will have to make all sorts of life-changing – and possibly life-saving – decisions in the coming weeks and months. The news is a blow, but the doctor has many other people to see, and only has time to give a brief overview of her diagnosis and the basics about what to expect. 

Our typical patient’s life has now changed irrevocably, but she feels unequipped to deal with whatever may lay ahead. Twenty years’ ago, this scenario would have been left right there. The patient would have been expected to cope largely on her own, occasionally being told by doctors and consultants what procedures she would have and what drugs she would take.  

But there has been a quiet revolution in recent years – a shift which is restructuring healthcare across the world. This revolution has come from digital. There is always a danger of over-romanticising digital. Etymologically the word comes from the Latin digitus, meaning fingers or toes – thus to be ‘digital’ simply means to use one’s digits when performing an action. 

But of course it now means so much more than that. ‘Digital’ now incorporates much deeper connotations of engagement, networking and commercial opportunity. Today, our patient can face her disease in new ways: by writing blogs about her progress for instance, or engaging with an entire community of patients going through similar treatments. This can help her to predict what could happen further down the road, or even help her through the difficult first few weeks following diagnosis.

She can also do some research online to find out what treatments are available beyond what her doctors are advising, giving her the confidence to seek out different options, or even find new clinical trials that could benefit her. The young woman has gone beyond being a patient and become an ‘ePatient’ – an evolution of sorts, and increasingly the norm as people further their engagement with online information.

The rise of the ePatient

For pharma, this represents a major new opportunity to not only promote new medicines via social media and disease awareness campaigns, but also to come out of the shadows, to become more transparent and – for the first time – engage with patients on a one-to-one basis.

Digital is now becoming the tool of choice for many pharma marketers, where the line between traditional marketing and digital marketing is so blurred, the two have essentially amalgamated. Increasingly, if you want to deliver a message – especially to patients – you have to go online.

But the pharma industry as a whole has not embraced any form of digital revolution as readily as other sectors. There are many reasons for this, with legal restrictions being chief among them, especially in the European Union, where rules forbid pharma from discussing its products directly with the public. This limits just how much – and what – it can say to patients. 

But whilst the industry may not have taken on digital wholeheartedly, some individual firms, and individuals within those firms, have taken up the challenge of finding a way through the legal quagmire. At the beginning of the year, those pharma companies willing to embrace digital came to the fore through an IMS Institute poll of the best pharma firms in social media. 

Johnson & Johnson, which also has a large consumer unit, came top by some margin according to the metrics of IMS, followed by a close cluster of other companies: GSK, Novo Nordisk, Pfizer, Novartis and Boehringer, respectively.

You would expect most of these at the top given their large budgets and digital willingness – although Boehringer, which almost defines itself via its social media presence, may feel a little disappointed to be sixth on the list. 

But whilst lauding the success of the top 10 firms, the IMS Institute was quick to caution that pharma may not be using these new media platforms to the best of their ability, and will need to invest more to engage with younger, digital-savvy consumers.

And this is a problem. The young cancer patient can benefit from digital, but a fundamental demographic difficulty remains: the majority of people who require prescription medicines are over 50 – with many larger groups in their 70s, 80s and 90s. Patients in these age brackets use social media far less than their younger peers and are therefore largely ignored by pharma’s foray into social media.

However, recent reports suggest the tide may be slowly turning. Specifically, an annual survey by a UK governmental communications group says that the emergence of tablet computers is behind a swift rise in people aged 65 and over using the internet. 

Drawn up by the UK government’s Office of Communication (Ofcom), this report indicates that, in the past 12 months, the percentage of older people going online rose by more than a quarter to 42%, which could fuel more interest in health-based media. Despite this increase, however, the oldest group of people still spend the least amount of time online of any adult age group. 

According to Ofcom’s report, the over-65s spend nine hours and 12 minutes online every week on average. By contrast, those aged between 16 and 24 devote about 24 hours each week to online activities. In healthcare terms, this means that younger, chronic patients may well be the greater beneficiaries of digital campaigns.

The same study found that half of the apps people download are redundant because they are used so infrequently. On average, the survey says, smartphone users have 23 apps installed – but make regular use of only 10.

This is a major problem for developers, especially pharma and health app creators, who require regulator engagement with users for their programmes to work successfully. Finding a way to engage with older patients – and holding the attention of the younger ones – remains a key challenge for pharma if it wants to nurture any digital revolution.

Pharma’s foray into digital

But just what has the industry done to engage with the ePatient? Pharma has traditionally been publicity-shy, hoping instead for its products to be better known than its producers. As mentioned before, there are good reasons for this as they cannot be seen to promote prescription drugs on these platforms, and have to be very careful not to cross any legal parameters when talking to users. 

But this has not stopped the industry using social media, notably Twitter and Facebook, in order to (legally) engage the general public. So how do pharma companies use these new channels? Many use Twitter to publish links to press releases, which are primarily of use for journalists.

Some tweet about events they are running/sponsoring. Others attempt to increase their public reputation by announcing plans to increase access to medicines abroad, or other seemingly philanthropic gestures.  

There appears to be less engagement on Twitter – visibly less anyway, as interactions and direct messages cannot always be seen. Most companies do enjoy a fairly large following, however. GSK’s main Twitter account has nearly 50,000 followers, Boehringer has 32,000, Sanofi 40,000, and top dog Pfizer is closing in on the 100,000 mark. (This seems to reflect global size: Pfizer is the world’s biggest pharma firm by revenue, so it’s no surprise it has the most followers.)

The majority of these firms follow very few people in return – typically just a few thousand or even a few hundred. These are predominately news services and other medical charities and groups. But pharma’s figures are fairly high compared to other industries – BP Oil, for example, has fewer than 2,000 followers, whilst Barclays Bank has only 22,000. This is more impressive given that Sanofi, Boehringer and others are not the household names that BP and Barclays are. 

But pharma’s use of Twitter has not always been positive. The first reported case of a tweet landing a company in hot water came in 2011 when Bayer was reprimanded by the PMCPA, which polices the ABPI’s Code of Practice in the UK, after its UK Twitter account promoted a prescription-only drug to the public when it sent two product-related tweets.

These tweets concerned the company’s erectile dysfunction treatment Levitra and its multiple sclerosis spasticity drug Sativex, both of which were published in a way that made them seem promotional. Bayer was hit with a major reprimand from the PMCPA, and fined thousands of pounds.

And last year a European NASDAQ disciplinary committee found virology specialist Medivir guilty of breaching its rules, after data from a clinical trial were posted on Twitter before their formal release. This case, however, was a little more complicated as it was not Medivir who sent the tweet, but rather a participant who took a picture with his smartphone at an event the firm was hosting.

The picture was then published on social media hours before the data was officially made available to the public, thus breaking NASDAQ rules. Much was made of these cases in the press – especially Bayer’s tangle with the PMCPA– but they certainly weren’t earth-shattering enough to warrant rejecting digital in all of its forms.

In Bayer’s case, the tweets were sent mistakenly with perhaps a slight misunderstanding of the lines between information and promotion. And Medivir’s example was again a mistake, rather than intentional – there should have been a direct conversation with attendees that data were embargoed. In reality, neither firm was looking to use these media to advertise.

Facebook

A bigger problem has stemmed from Facebook, after the social media platform decided in 2011 that firms running corporate profiles can no longer simply delete comments they didn’t like. This means that companies can only retroactively delete comments if they break Facebook’s terms, or are illegal.

Janssen’s award-winning Psoriasis 360 Facebook offering was quick to fall foul of these new rules, and in 2012 the firm said it was ‘forced’ to remove the page – which also had Twitter and YouTube counterparts – after an increasing amount of ‘troublesome comments’ were posted.

Janssen said at the time: “Whenever a post on this page [Psoriasis 360] mentions a specific drug by name, or talks about the efficacy of a particular treatment (or its side effects), we have to ask for it to be changed, or pull it.” 

The J&J pharmaceuticals subsidiary went on to say that this was ‘stifling worthwhile discussions’, and constantly removing these posts simply become too onerous for the firm. Psoriasis 360 was seen as one of the shining beacons of what pharma could do with digital, but its removal from Facebook was worrying given that the firm had done nothing wrong – it simply couldn’t keep up with the public’s comments. 

This is the reality of becoming more open on the internet – a company that was once immune to direct public criticism can instantly become the target of ‘trolls’, rather than receive helpful feedback from people who are genuinely upset or concerned about a firm or its products.

Pharma may well have to develop a thicker skin and recruit more staff who are used to monitoring web comments. The travails here are certainly ones that pharma must be aware of, but if it wants to succeed in a brave new world risks will have to be taken – and understanding risk is, after all, what the industry is all about.

ROI questions

An argument remains that too much time and effort is being spent on digital communications, when the primary job of pharma should be to concentrate on its research and development. And a large question mark hangs over just what the return on investment (ROI) is for firms who want to grow their presence on platforms such as Facebook and Twitter. 

Digital is a major buzzword and becoming all-encompassing at many pharma conferences. This was no more evident than at the recent eyeforpharma offering in Barcelona, where much emphasis was put on the use of digital to aid the industry’s future.

But this focus was at one point sharply put into perspective by a single slide, that showed only 6% of pharma’s entire marketing budget is spent on digital marketing. The question is: just how measureable is this 6% investment? Have more drugs been sold as a result, and is this even the point for pharma’s foray into digital? Can engagement be successfully measured and pitted against the cost of creating a campaign? 

These questions are not benign and the lack of answers is what prevents many pharma firms from fully embracing digital. In an interview with Pharmafocus in 2012, during the launch of Syrum – Boehringer Ingelheim’s Facebook game designed to promote disease awareness campaigns – its creator John Pugh dismissed enquiries about ROI, saying it ‘wasn’t relevant’ to ask that sort of question in relation to a digital operation. 

ROI is a key component of digital which is not discussed readily, but remains important to chief financial officers and to the healthcare payers who are ultimately funding pharma. The marketing budget for digital may certainly be small, but it still represents billions of dollars across the industry – and a good prediction of ROI is surely a necessary part of any business plan.

Embracing digital for the right reasons

Ultimately, as is so often the case with pharma, the issue boils down to trust: patients and lawmakers want to know that pharma’s use of digital media – and indeed its interaction with patients – is based on sharing information openly and helping to improve the experience of having a condition, whilst also aiming to deliver better medicines. 

It should not be, as some fear, an attempt at ‘back door’ direct-to-consumer advertising or in any way promotional. There is an opportunity here for pharma and medical communication firms to help shape the future of healthcare and chart the course of the ePatient. 

Our young cancer patient has now been given a louder voice and a community to engage with – and all at the touch of a button. The patients’ needs must remain the top priority for pharma and doctors, if the promise of digital is to be fully realised.

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