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Small steps

Despite having to toe the line of European regulation, there are ways in which pharma can move forward with social media

Little boy walking along a crack in pavement with red hat on For some time, media coverage has implied that the opportunities of web 2.0 are slipping through pharma's fingers. Articles paint the industry as risk-averse, plagued by regulatory restrictions and fearful of digital innovation. Spokespeople for the industry, however, state that these accusations are greatly exaggerated and that they are - albeit tentatively - developing digital initiatives that seek to capitalise on the web 2.0 promise. Even with the obvious regulatory constraints that currently limit pharma from fully embracing the more interactive elements of social media, more is happening on the ground than critics would have you believe.

"Nowadays, most companies have someone in place to look at digital marketing and to see where it can add value to the marketing mix," says Becky Wills, account director, VCCP Health. "These are the people who want to embrace it and they are asking 'what can we do?' rather than looking at what we can't."

So just what are they doing?
Last year, Boehringer Ingelheim became one of the first European pharma companies to use Twitter as a means to communicate corporate messages. It is not alone in seeing the latest social media phenomenon as a powerful tool to deliver press releases and provide disease-specific information, but it remains one of the few pharma companies to indulge in the more conversational aspects that Twitter enables. Boehringer is also setting up a stroke channel on YouTube to provide disease-awareness videos and has already used doctors.net.uk to promote its products to a closed community of clinicians.

Pfizer and GlaxoSmithKline (GSK) are also embracing the web 2.0 platform; Pfizer used YouTube as part of its award-winning campaign to tackle counterfeit medicines and, like many other pharma companies, uses the same medium to assist in clinical trial recruitment. The company also announced that it is joining Twitter soon. GSK has a YouTube channel, GSKVision, which includes videos around reputation management and careers, as well as two official Twitter channels – one to support its US blog and the other to recruit.

Numerous other examples of companies exploring the potential of digital media are being tracked and listed online at: www.doseofdigital.com/healthcare-pharma-social-media-wiki/

Mute point
So why, then, has the industry gained a reputation for inactivity? The answer lies in the absence of dialogue. Web 2.0 is founded on the principle of conversation, yet at the moment, pharma's inability to engage in open dialogue with its stakeholders has led to the accusations of a promise unfulfilled. Pharma wants to talk, but, in Europe at least, it knows that the regulations would make such attempts risky.

Legislation that governs dialogue between the industry and patients is emphatic and can be interpreted as even more rigid than the ABPI Code. Ian Dodds-Smith, partner and co-head of global law firm Arnold & Porter's Food, Drug and Medical Devices Practice Group, explains: "EU law has taken a traditionalist view that information about medicines and treatment with medicines is the province of doctors and not manufacturers. The overarching provision, therefore, is that manufacturers cannot advertise their prescription only medicines (POMs) to the general public."

This is well understood, but the critical aspect lies in making the distinction between information and advertising, and this is the chief bone of contention. "The relevant directive defines advertising as any form of information provision designed to promote the prescription, supply, sale or consumption of a medicinal product," says Dodds-Smith. "This very broad definition, which focuses on the subjective intention of the person providing the information, excludes categories of information supply that are not deemed advertising; factual information and announcements, provided they contain no product claims and information relating to human health or disease – which covers disease awareness campaigns – as long as there is no reference, even indirect, to medicinal products. If you're not within those exemptions, it may be said you are advertising and if you're advertising a POM, you're in breach of the law. In many member states, including the UK, this carries criminal sanctions. Industry's caution, therefore, is hardly surprising."

Engaging online with patients carries with it a risk that conversations may inadvertently lead to the discussion of products and, as sponsor of the site, a pharma company would be liable. 'Moderating' discussions to avoid this would, in many cases, be resource-heavy and impractical, while 'editing' the discussion would dilute the spirit of transparent conversation and could be regarded as censorship.

How does pharma move forward?
The first step may be to address the wider issues of trust and reputation that have perennially plagued pharma. At its conference earlier in the year, the ABPI launched the Trust Initiative, which will include a nationwide 'conversation' between its members and around 8,000 patients, clinicians, payers, politicians and journalists. The project aims to look at the reputation of the industry and identify ways in which it can build trust in the sector. It follows the successful  'Attracting Debate' initiative by Pfizer in the UK last year, and is being guided by a Trust Board that includes Colette Goldrick, head of international and public affairs and policy, Europe, Pfizer.

Goldrick, who is also expanding the ongoing Pfizer programme into Europe, believes the initiative is central, not only to understanding all stakeholder groups, but also to developing an environment through which pharma is able to engage with them in an open, responsible and responsive way. "The digital channel is undoubtedly going to play a major part in this," she says. "At Pfizer, the exercise started in a very traditional face-to-face manner – if we'd tried to begin this as a digital exercise, it would have failed because if people don't have trust in the first place, anonymous contact is not going to help. But we are now at the stage of rolling this out online, not only as a way of communicating progress, but - in the future - for real-time discussions with our stakeholders online."

For many, the conversational model represents utopia but, at the moment, pharma is only halfway to paradise. As Martin Hensen, head of eStrategies, UCB, puts it, pharma is not yet there with web 2.0, it's more like web 1.5. Health is, of course, one of the most widely used internet search terms, but if people don't trust pharmaceutical companies to provide information, the debate cannot progress. Winning trust could become the first step towards forging a more communicative environment for pharma with all of its customer groups.

Ed Purkis, editor of the Virgo HEALTH 'Healthy Conversations' blog, which encourages discussions around online pharma communications, concurs: "Enhancing the reputation of the industry is a long-term priority – creating dialogue and debate about trust and reputation, in a positive way, is extremely important. Web 2.0 is a perfect vehicle for that discussion."

The digital channel also represents a powerful medium through which pharma can learn more about its customer groups. In an era that preaches customer-centricity, the web can provide real-time insights into stakeholders' needs and drive commercial strategy. Simon Quayle, manager, corporate identity and communications, GSK believes this is a major attribute. "Yes, we want a share of voice but, for me, this is not an advertising opportunity, it is a great in-bound channel to gain insight from our customers and stakeholders."

Clearly, social media is as much about listening as it is about talking. There is much to be learned from surveying the blogosphere. "Political moves to patient-centred care and personal responsibility for health have encouraged the public to engage with health and learn more," says Aaron Pond, senior account manager, Aurora. "The web provides a natural platform for this. It is not surprising that people will want to share views and experiences about health because it is an emotive issue. Our challenge, in turn, is to find the most appropriate ways of communicating with our audiences. And the web is just one of them."

Stefan Ziolkowski, director eBusiness at Boehringher Ingelheim, believes the digital channel may be a way of adding value to the customer interaction at a time when health budgets are under pressure. "As an industry, we need to contribute to healthcare rather than just sell drugs," he says. "One key area is patient adherence. How do we make sure that patients have access to the right medicines and are taking them when they need to? We have a duty of care to ensure that the information we supply is appropriate and that patients take their drugs if they need them. The digital platform could be perfect for a holistic disease awareness effort in areas such as this, providing a value-add for the NHS and for patients."

Within the constraints of the current legislation, disease awareness campaigns represent a good digital opportunity for pharma. "Instead of jumping in to certain levels of engagement and active dialogue, there are opportunities to gain 'digital confidence' by speaking about the condition rather than the brand," says Jonathan Kay, head of brand management for TNS Healthcare, a Kantar Health Company. "Here, the industry can determine how the well-defined rules that govern offline communications can be translated online."

While more and more companies seem prepared to dip their toes into the water, knowing when to swim ashore is another critical factor. "You have got to have an exit strategy," says Simon Quayle, who is helping to develop a series of web 2.0 pilot projects at GSK. "First acknowledge the risk, deal with it and mitigate it. Then be brave. The industry has to try things and, as long as there are clear business objectives behind all actions taken, it will be worth the experiment. Being brave, however, is not just about experimenting, it's also about being bold enough to know when to bin it. If it's a six-month pilot, you've got to be prepared to close it down and deal with it."

The journey towards fully conversational web 2.0 will depend on a seismic shift in legislation. Right now, the stumbling block remains that distinction between advertising and information. Frustratingly, European Commission proposals, which may have helped move towards a clearer definition of this, have recently been rejected by member states (the UK not among them). "Companies, through their trade associations, have lobbied the commission on what they view as an important role for industry," says Ian Dodds-Smith. "The commission has put forward a sensible proposal, which is still on the table, but it has met with opposition from some member states, who are terrified that anything that is a foot in the door for drug companies to engage directly with patients will automatically increase the drugs bill. Given that the fundamental barrier to progress lies within the European law, the only baby step the industry can make is to work with what the commission has proposed and the objections raised, and press ahead."

In the absence of new regulations, the industry needs to maintain the debate and work together to establish guidelines on how it can proceed within the current legislation. "Companies need to put competitive edge aside and develop an industry-wide consensus on how to move forward with social media so that we can engage, have conversations and take small, but meaningful steps," says Angie Wiles, joint CEO, Virgo HEALTH. "Progress will come from collaborative discussion. It is a collective responsibility at both company and industry level to develop something that will ultimately benefit everyone – industry, health professionals and, crucially, patients."

It is encouraging that industry organisations such as the HCA and PM Society are already stimulating the debate. Both groups have held recent workshops to discuss digital media, and the PM Society has even introduced a Digital Marketing Working Group to generate clearer guidance for its development in the UK. The conversation, it seems, has only just begun.

The Author
Chris Ross is a freelance writer
To comment on this article, email pm@pmlive.com

10th August 2009

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