Using Social Media for Your BrandHow to start

How to keep goingHow to stay out of trouble

How to be effective and relevant

Developed by Michele BennettChief Operating Officer, Wool Labs, LCCIn collaboration with QooQoo

• Discovery, Clinical and Regulatory Affairs professional, computer engineer, behavioral and data scientist

• 25 + years experience in Pharmaceuticals, Devices, and Biotech including Marketing, Competitive Intelligence and Market Research

• Co-founder and COO of Wool.labs which creates tools for social media monitoring and analysis (WebDig), engagement (DigBar), social search, predictive intelligence (Spark), and more.

• The company has been working with social media in Healthcare for 5 years – longer than just about anyone else.

• We publish our own studies as well as work with clients across the healthcare continuum.

About Me

• How did the Internet become so scary?

• We all use it every day. We panic when the power is off (and the Internet goes down). A day without the Internet eats away at most of us; we feel unproductive and out of touch. We capitalize Internet.

• So the saying, “with great power come great responsibility” should apply to the Internet. But it does not.

• The Internet holds great power – powerful content, the power to influence, the power to make people move, the power to effect change

• The Internet has no accountability – you can put anything there, regardless of truth, validity or rationality. (Psst...It lies).

• The Internet knows everything, knows nothing, contains billions of important pieces of information and even more junk.

• So, it is Chaos and Wonder. Power and Lies. Data, data and more data.

• And we can’t get enough. But we hesitate to use it well.

Lions, Tigers and Bears, Oh My

• Tens of millions of people using the Internet for medical advice, to check their physicians’ diagnoses, to share their health experiences, to provide advice to others, to self-treat, to break all of the rules told to them by their doctors, to define their healthcare

• It’s a medium that you cannot control. Influence maybe but not control.

• It’s truly interactive – two-way, ten-way, ten thousand–way communication.

• It’s everywhere – computer, tablet, phone, TV. No other medium in recent history has captivated people so.

• It moves lightening fast and cannot be prematurely halted.

• It generates millions of connections, data points, conversations, opinions, beliefs – simultaneously and in as many directions.

• And if harnessed just right, the most powerful marketing vehicle we have ever had at our disposal.

For Us, What is Social Media?

• Tens of millions of people talking about your brands and you’re not in the room. – If that was happening in a real room, you would not just stand by and watch. (Unless

everyone all had spears and then I might just kind of just slip away, but that seems unlikely.)

• Everyone who impacts your products is there –patients, caregivers, physicians, nurses, managed care professionals, pharmacists

• And then there are some interesting stats:– Less people are going to their physicians - Insured Americans are using fewer

medical services, raising questions about whether patients are consuming less health care as they pick up a greater share of the costs. – Wellpoint 2012

– Compliance is a problem that is costing America’s healthcare system a lot of money- One-third to one-half of all patients do not take medication as prescribed, and up to one-quarter never fill prescriptions at all. Such lapses fuel more than $100 billion dollars in health costs annually because those patients often get sicker. –PharmaMarketer 2012

Why Take on The Challenge?

• More stats: Harris Interactive 2011– Physicians are wired, online and using social media

– 94% of physicians are using smart phones to communicate, manage personal and business workflows, and access medical information.

– Nearly 90 percent of physicians use a social-media website for personal use, and 67 percent use it professionally, according to a survey of 4,000 physicians by QuantiaMD

– The number of people looking for health information on the Internet is increasing every year

– While the percentage of adults who go online (79%) has not changed significantly for several years, the proportion of those who are online and have ever used the Internet to look for health information has increased to 88% this year, the highest number ever.

– Fully 81% of all eHealth consumers have looked for health information online in the last month. On average, eHealth consumers do this about 6 times a month.

– Very few eHealth consumers are dissatisfied with their ability to find what they want online. Only 9% report that they were somewhat (6%) or very (3%) unsuccessful. And only 8% believe that the information they found was unreliable.

Why Take on The Challenge?

• What do patients look for: Pew Internet Project 2011– 66% online for information about a specific disease or medical problem (perennially

in the top spot).

– 56% for information about a certain medical treatment or procedure.

– 44% for information about doctors or other health professionals.

– 36% for information about hospitals or other medical facilities.

– 34% regularly use blogs and forums for health information (60 million people)

– 33% for information related to health insurance, including private insurance, Medicare or Medicaid.

– 29% for information about food safety or recalls.

– 24% for information about drug safety or recalls

– 22% information about environmental health hazards.

• Access, Reach, Engagement, Frequency – the hallmark of all marketing converges on the Internet and in social media. There is no venue bigger, faster or more cost effective to use. So we have to figure out how.

Why Take on The Challenge?

Why Take on The Challenge?

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Highly knowledgeable

Communication

Shared decision-making

Honesty

Listening

Respect

Integrity

Open to differing opinions

Having enough time together

Interested in prevention

Open to more holistic approaches

Supportive

A good teacher

Feeling cared for

Patience

Promptness

Sensitivity

Flexible

Other, please specify

Patient ValuesMost Important Characateristics of

Those Providing Healthcaren = 101

• But our world has rules even when our audience has none

• We have to play but a set of guidelines that govern what we say, when we say it and who we say it to.

• Our audience says whatever it wants even if it is incorrect, tells others what to do even if it’s off label, and can have great influence over many

• So in a world where we have to play by rather strict rules with an audience who has no rules, how do we master social media and Internet-based dialog and

– Take advantage of having so many ears and eyes for our messages

– Understand and address the concerns of internal departments

– Not get in trouble with external regulators

• That’s what we are going to talk about, try it on for size and feel, and look toward a path forward

We have Rules

• Just like any other tool in regulated industries, social needs internal procedures and policies for use.

• As we can see from where the FDA started in guidelines, no general social guidelines are going to be forth coming soon

• So organizations will have to create their own way using the guidelines that we have already.

– No SM guideline will ever allow companies to not include fair balance because the medium doesn’t easily provide the space.

• So using common sense and existing FDA rules for communications, companies can move forward.

• Every organization has its own threshold for risk and their own way of interpreting the FDA guidelines

• But we can provide some foundation for how to get started

Rules of the Game

• In a regulated industry, no medium should be used without policies

• What do policies have to cover? You need three:

1. Listen & Learn

2. Internalize & React

3. Respond & Engage

• In general, social media policies need to be

– Brief and direct

– Clear about roles and responsibilities

– Address guidelines, risks and benefits

– Applied internally and well as externally (e.g., include a policy on employee and employer actions)

– Real, realistic, and implementable

Rules of the Game

• Where to start? • Engagement? Ok, but its usually the hardest place to start and typically

poses the most risk. We never recommend starting here, ever.

• Listening and learning is by far the best place to begin

• Why? Maximum benefit, minimum risk

• Easiest (yes, we know that is a relative term) guidelines to develop, get approved, use, track, and benefit from and low risk of saying something by which a letter, warning, internal reprimand or more damages you or your company

• But effective Listening programs need to also be accompanied with methods of internalizing and reacting to findings

• If not, brands risk running into internal confusion and even unnecessary panic and perhaps even external problems.

What Game?

• Listening and learning provides fuel and data for any marketing, sales and communications effort– Listening programs can be highly measureable, cost efficient and targeted methods

for collecting data on any audience type.

– Ensure that your listening parameters are aligned with brand strategies and always set metrics for success

• Encourage listening despite perceived risks– Social media monitoring should be encouraged, and policies should address the

method of monitoring, and what is done with the results.

– A manufacturer can learn first of additional indications and real-world risks that did not surface in trials. It is inevitable, positive, and responsible

• Its not a one time thing– Many marketers equate social media monitoring with conducting a one-time market

research project. The results are analyzed, used to guide decisions and messaging, then the study is placed in a binder next to the one from last year’s sales meeting.

– However social media is fluid, and challenges and opportunities are perpetual.

– Think of it as a constant source of the latest information you need to know

1. Listening & Learning

• There are tools to monitor the social media in a manner consistent with existing guidelines– Any tool you use must pass certain tests around the collection and store of PII and

how any potential non-reportable AE’s are collected and reported to you

• Listening programs can be proactive management tools– Today’s tweet can be tomorrow’s Today’s Show story. (We’ve seen it happen).

– Social media is an opportunity for a proactive firm to address problems before they start.

• Guidelines for listening should include:– Treatment of PII, adverse experiences, unexpected learnings, off label requests and

suspected usage

– Departments involved in listening, tools used and for what purpose, metrics involved including thresholds for signals

• But don’t focus on the scary and negative aspects.– Internet dialog contains so much valuable and useful data – competitive

intelligence, market research, drivers and barriers to sales, patient adherence answers, physician motivators – its all there and your competitors know it too

1. Listening & Learning

• Legal & Medical oversight

– Monitoring research should be done with oversight to ensure the methodology is appropriate, reporting obligations are held, and with legal and regulatory guidance on how to proceed with discoveries that might have labeling implications.

• Fear of Adverse-Events is not warranted and not an excuse– In the almost 5 years we have been monitoring SM, we have yet to come across a

FDA-defined reportable AE.

– People do report problems though where manufacturers can identify and document instances of recurring adverse events or off-label use

– If a blog, video or chat comment does contain sufficient information for reporting, it should be routed urgently to the team responsible for reporting AEs.

– This solution is common sense, but “fear of AEs” is one of the largest hurdles facing manufacturers that wish to engage more deeply with customers.

– You cannot proceed to engagement until you address this concern completely and this is the stage at which it should be addressed.

2. Internalize & React

• “Not Looking at Internet” is Not a Sound Legal Defense.– Lawyers are legitimately concerned that evidence of monitoring could create an

FDA expectation that the manufacturer is obliged to read and respond to all of social media.

– That is obviously impractical and an the FDA will not soon demand manufacturers to read the entire Internet.

– However if a product issue is identified, trending, and ignored, a poor defense would be “we didn’t know it was happening because we didn’t use the Internet.”

– It is not unreasonable to expect the FDA to take action on a company that did not update labeling based on newly evident side effects that are well documented online. It is also reasonable to assume that manufacturers would be expected to take reasonable efforts to clarify labeling in prominent forums where patients or doctors are promoting off-label use. The current guideline is one step away.

• Don’t “Freeze” Corporate Efforts or Look the Other Way– It’s important that social media monitoring be shared beyond the group doing the

monitoring, so medical affairs or legal can determine if the insights warrant FDA communication. So in effect, by “freezing” or “avoiding” social media monitoring, manufacturers may be taking a greater risk than reasonable efforts to monitor and respond.

2. Internalize & React

• Guidelines at this stage need to include– Methods for internally reporting issues or concerns raised by dialog including what

to do with labeling concerns, marketing and sales issues, potential legal issues, PR and communication needs, external affairs and more

– Each department playing a role with listening results needs their own policies including escalation thresholds

2. Internalize & React

• Policies for engagement should come after policies for listening and internalizing

• Monitor First – A best-practice related to social media is to monitor mediums for a period (3 to 6

months) before engaging

– This gives an organization time to understand the context, and the appropriate approach for engaging.

• Use existing credible communities– Manufacturers publishing or hosting social media can be faced with serious

risks, regulatory constraints and cannot do so with objectivity.

– As a result, marketers should look to reach their audience via appropriate social media sites and tools using paid and earned media.

– Credibility in social media is earned – extremely so. In the current environment, manufacturers are not completely trusted and biases can be overcome but by learning and only engaging when you know enough to be perceived as helpful, which varies by category

3. Engage & Respond

• Know Who Matters (sometimes, it’s a collective Who)

• Social-media engagement requires– Addressing not just the concepts of “headline risk” – what journalists and the media

have to say but

– Addressing the concerns of communities or individuals with the speed and attention otherwise reserved to investment or media inquiries.

• Set Guidelines to Avoid Mistakes or Apathy– Marketing should have clear policies on advertising around social media, and this is

similar to advertising in print or television.

– If the ads are placed adjacent to condition-specific information, they should be unbranded and not branded unless fair balance on the page can be included.

– Just as manufacturers gain comfort with digital advertising, you will gain comfort with running ads wherever their target customers are, and not fear ad placement surrounding uncontrollable social media.

– The ad may be the only appropriate way to reach some patients, and most consumers know that the difference between ads and other content.

– Actually answering posts in a social forum requires a tool for delivery and tracking of the post as well as for the simultaneous delivery of fair balance

3. Engage & Respond

• Revise, Review, Processes, & Develop a Crisis Plan:• For good reasons, manufacturers maintain thorough and somewhat lengthy review

processes.

• However public relations professionals are often granted “fast track” reviews for time-sensitive matters like product issues or launches.

• Similarly, the process by which ads are approved cannot facilitate handling of a timely event in social media. Some matters need rapid attention and resolution.

• It is highly possible that at some time in the future, a product recall could involve a manufacturer directly communicating with customers, rather than shaped by the media, to probably a much better outcome

• Other industries have social media commentary ready for any major disaster

• All companies should have a “crisis-management guide” that includes mediums for mass communication that are not dependent on print and television reporters.

3. Engage & Respond

1. Create your first pass of a listening policy that addresses how data is collected, who gets what type of information (data, analysis, etc), and what constitutes a signal or alert of significance, how any issues will be reported to you, and who gets what if thresholds are met.• The FDA looks to see if you have a policy and if you are following it. It is a higher risk

to have a policy that you don’t or can’t follow than not having one at all.

2. Define a listening program or pilot that runs 3 – 6 months

3. Test the program against the policies and adjust accordingly

4. While the listening program in running, start on your internalization and reaction policies. Include marketing, medical, legal, and communications. Keep them short and direct.

5. Compare your internalization guidelines to the results of the listening analysis to check for the need for adjustments.

6. Once your Listening and Internalization programs seem to work, then start on Engagement Guidelines and options.

Armed and Dangerous. Now What?

7. Engagement can come in multiple forms. Yes, online but also offline, in office, via your branded website, in the community, in hospital. Think about the broader concept of word-of-mouth to find ways to engage that you already use. The goal is to build trust and credibility.

8. If you are ready to engage online, use tools to ensure that only approved responses are used and tracked for marketing, medical, regulatory and legal review and compliance. Think about programs in which you seed the online communities without you directly engaging – KOLs , mentor programs, community leaders, self-managment tools

9. Be prepared to handle bad news. Know what bad news is and appropriate reactions internally as well as escalation. The more prepared the organization is, the less likely it is caught off guard.

10. Listening, internalization and engagement all work together and are progressive. If you start in the middle, you increase risks with one risk being the organization will not want to try social again for a long time.

Armed and Dangerous. Now What?

Ways Others Use Social MediaProduct Launch

Market ResearchMarket Strategy

Scientific PublicationPatient Understanding and Engagement

Sales StrategyPhysician Influence

Hospital Relationship Development

Example Scenarios

Avandia

When bad things happened to good drugs

• In 2003 and 2004, the benefits for most patients outweighed risks and for the most part patients were more hopeful; most of patients’ struggles were more connected with diabetes than with the brand.

• In 2005, patients begin to become aware of risks as well as weight gain and edema. They openly discuss it but feel physicians are largely downplaying their concerns. Some patients begin to become more vocal and reach out to be heard. Negative sentiment rises exponentially.

• In 2006, patients start to connect their concerns to congestive heart failure. This year showed early warning signs of problems for the brand. Loss of trust is the next predictable problem.

• 2007 was a pivotal year - where patient trust starts to drop dramatically. Patients question their physicians and begin to take control over their medication choices. Patients start referencing GSK, which in our experience is rarely good. Vioxx comparisons are raised and legal action is easily predicted to be the next course of action.

Situation Set Up

• By 2008, patients display open hostility to the Avandia, GSK, and even their physicians. Legal discussions exploded and overtake diabetes-related conversations in volume. Trust is gone from conversations.

• In 2009, patients become more resigned and loss of trust starts to translate to the industry. Patients have stopped listening and new information that could have been used to sway opinions is dismissed. Conversations move from patients to industry analysts, marketers, and consumers who are not patients.

• By mid 2010, patients are resolute in their decisions. They are no less angry at Avandia and GSK but are now also angry at the FDA as they see the FDA as not listening either.

• At no time during the controversy over the last several years has anyone reached out to the patient base to explain or reassure. Patients tried to decipher complex studies and analyses – and, right or wrong, once they drew their conclusions, they were not going to be swayed otherwise.

Situation Set Up

Situation Set Up

Situation Set Up

1

2

3

5 5

4 4

0

1

2

3

4

5

2004 2005 2006 2007 2008 2009 2010

Language Intensity Level - AvandiaMeasure of the Level of Negativity in Patient Reports

Low = 0--1 Moderate - 2-3High = 4 - 5n = 2,111

• If this happened in 2012 with the technology available now, what would you do and when?

• Who should have been involved in listening, internalizing and possibly engaging?

• Listening would have revealed interesting results. How would you like to see your company internalize this type of information?

• Should the brand have engaged with patients, physicians, media. And how? Remember engagement doesn’t have to be in kind.

• In hindsight, so much is obvious. But there are always higher risk products on the market; maybe those with high benefit but limited populations. Does that change how a brand proceeds?

• What are the risks and benefits in learning information that may not be initially well received in the organization?

Opportunities for Discussion

Example Scenarios

Jakafi

Real data powering product launch

Situation Set Up

-12.5

-9.6

-8.4

0.0

-0.9-1.8

0.4

-0.3

0.0

-14.0

-12.0

-10.0

-8.0

-6.0

-4.0

-2.0

0.0

2.0

2000-2003 2004 2005 2006 2007 2008 2009 2010 2011

Myelofibrosis Sentiment IndexRatio of Positive Conversations to Negative ConversationsRange of Index: -100 (all neg) to 100 (all pos). 0 is neutral

N = 1054Confidence Interval = 95%Margin of Error= 2.96%

Situation Set Up

1%

2%

5%

4%

2%

5%

4%

10%

13%

0%

2%

4%

6%

8%

10%

12%

14%

2000-2003 2004 2005 2006 2007 2008 2009 2010 2011

Awareness & Support IndexPercent of Treatment Conversations where Patients/Caregivers Discuss Dissatisfaction with Watch & Wait as Treatment Optionn = 1054 Confidence Level = 95% Margin of Error = 2.96%

Situation Set Up

78%

64%

58%

51%

43%

35%

30%27%

29%

22%

32%

40%44%

50% 52%

46%48%

45%

4% 2% 4%7%

13%

24% 25% 26%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

2000-2003 2004 2005 2006 2007 2008 2009 2010 2011

Zero to Low Knowledge Moderate Knowledge Strong Knowledge

Awareness & Support IndexCommunity Members' Disease Knowledge

Percent of Conversations by Knowledge-Level Over Timen = 1054 Confidencel Level = 95% Margin of Error = 2.96%

Situation Set Up

13%

3%

25%

1%

11%

17%

61%64%

53%

0%

10%

20%

30%

40%

50%

60%

70%

2000-2003 2004 2005 2006 2007 2008 2009 2010 2011

Awareness & Support IndexPercent of Conversations on Cancer-Oriented Sites Over Time

n = 1054 Confidencel Level = 95% Margin of Error = 2.96%

Situation Set Up

No Cure9%

More Treatment

Options

16%

Watch & Wait9%

Caregver/Patient Support

20%More Professional Interaction

7%

More Professional Knowledge

14%

More Information

25%

Pain Pointsn = 1054

Confidence Level = 95%Margin of Error = 2.96%

• Jakafi is the first treatment option for patients with myelofibrosis that actually treatment the disease rather than just addressing symptoms

• Based on what we have shared today, are there recommendations you would make for the brand team?

• Should they continue monitoring and why?

• Should they engage and how?

• Are there things you can think of that stand out as interesting and actionable?

Opportunities for Discussion