Is Pharma Really "Listening" to Patients on Social Media?

After criticizing Astrazeneca's @AZHelps Twitter account as being a poor model for use of social media by the pharmaceutical industry (see @AZHelps: Is This a Good Model for Pharma Use of Social Media?), I received several comments that made me think a bit more about how pharma marketers are trying to adopt a new communication paradigm without giving up their old model of communication. That old model is essentially "tone deaf" when it comes to "listening" to consumers.

Don't get me wrong. Pharma marketers "hear" what people are saying on social media sites such as Twitter. They just are not actually listening to what consumers are saying and understanding.

Let's look at @AZHelps as an example of this. It appears that @AZHelps seeks out Tweets that mention problems people are having affording Astrazeneca medications. Apparently, AZ monitors social media using tools such a V-Fluence (see comments to the post cited above). This is not the same as having a real person monitor social media, but it's a necessary tool to get an idea of what people are saying about your product out there. But just like any automated program, it lacks human intelligence -- it hears, but does not listen.

One post the @AZHelps bots pricked up was this one, which was posted by @busterwilson:

"Almost home. Pat drove most the way. Second day of the trip w/extensive migraine! NO Zomig cause Obamacare made insur. Not wiiling 2pay4 it!"

After a couple days delay, @AZHelps responded with:

"@busterwilson Saw your tweet about access to or the cost of ZOMIG® (zolmitriptan) AstraZeneca may be able to help. Call us @ 800-236-9933"

Did @AZHelps actually "listen" to what @busterwilson was really complaining about? No. They heard what they wanted to hear and responded with a "solution" to the problem they thought they heard. But they didn't really listen to @busterwilson's real gripe, which was about "Obamacare."

Let's use an analogy: How is social media like helping your wife deal with a problem?

A: It's been my experience that when my wife complains about something, she is not looking for me to give her a "solution," but for me to listen to her and understand her problem. The same may be true for helping patients who complain about products. Before you offer a solution --- ie call this number -- have a conversation and make sure you get to what the real problem is. In the case I cited here, @busterwilson was spouting off about "Obamacare" and no amount of free ZOMIG is going to put him at ease about that.

@AZHelps did not bother to learn more about @busterwilson and his Zomig problem, let alone about his problem with Obama. Turns out that @busterwilson is "a husband, father, grandfather, media personality, Sheriff's Chaplain, motorcycle rider, and lover of Jesus!" It sounds like he has an agenda much bigger than the price of Zomig.

Of course, @AZHelps is not going to get into a discussion about "Obamacare." AZ is more interested in getting IT'S message out about Zomig and making sure people call that 1-800 number.

@AZHelps: Is This a Good Model for Pharma Use of Social Media?

Recently, @jilliantate (Jullian Tate), Director, digital strategy, for Integrated Media Solutions in Los Angeles, and someone I follow on Twitter, tweeted this:

"Wow. Great article on how @astrazeneca is using Twitter to monitor mentions of products, and respond. #socpharm #fdasm http://bit.ly/crk3K8"

Naturally, I had to have a look and see what all the fuss was about. In the blog post that @jillintate referred to, Bruce Grant was said to have pointed to AstraZeneca as "one company with a solid grasp of the social-media realm. The company has used its Twitter account to monitor any tweets about its products, so that it can respond to consumers directly."

The Twitter account Grant was undoubtedly referring to is @AZHelps and NOT @Astrazenca (AZ has several Twitter accounts). Practically every tweet made by @AZHelps is similar to these:

"@redban Saw your tweet about access to NEXIUM® (esomeprazole magnesium) AstraZeneca may be able to help. Call us @ 800-236-9933"

and

"@busterwilson Saw your tweet about access to or the cost of ZOMIG® (zolmitriptan) AstraZeneca may be able to help. Call us @ 800-236-9933"

@AZHelps averages less than one tweet per month! The latest tweet -- to @redban, a husband, father, grandfather, media personality, Sheriff's Chaplain, motorcycle rider, and lover of Jesus! -- was made on July 7, 2010. It was in response to this tweet made by @busterwilson on July 5:

"Almost home. Pat drove most the way. Second day of the trip w/extensive migraine! NO Zomig cause Obamacare made insur. Not wiiling 2pay4 it!"

It seems to me that this is a very inefficient way for AZ to use social media resources. First of all, taking two days to respond to a tweet is an eternity in today's social media world. I hardly remember what I was talking about 2 hours ago, let alone 2 days ago!

It's also interesting that @AZHelps suggests that @busterwilson call 800-236-9933 rather than visiting the AZandMe.com Web site, which is what was recommended to me when I called the number.

I am not sure, however, that AZ can help people like @busterwilson. When I visit AZandMe.com, it informs me right up front "If you are an individual making $30,000 or less or a family of four making $60,000 or less you may qualify for an AZ&Me™ Prescription Savings Program." I doubt that a media personality and Sheriff's Chaplain such as @busterwilson would qualify.

Although the people answering that AZ number were very friendly and competent, I spent about 15 minutes on the phone before I got the information I needed. Wouldn't it be much better for @AZHelps to refer people to the Web site rather than the 1-800 number?

The only advantage I would see in calling the 1-800 number is the opportunity for AZ to have a real person to answer your questions. In this case, my experience with call center people was positive.

Still, I don't find this a very "Wow" use of social media. What do you think?

Will Avandia Failure Lead to More Closely Supervised Clinical Studies and Longer Patent Life for New Drugs?

In a BMJ editorial, editor Fiona Godlee contends that Avandia "should not have been licensed and should now be withdrawn." She cites problems that FDA discovered with the RECORD post-marketing study and finds fault with regulatory agencies' oversight of such studies.

Regulators should "should require a higher quality of evidence," Godlee says, "including proof that new drugs are better than existing drugs before being licensed. And if they do ask the manufacturer to undertake post-marketing trials, they must do a better job of overseeing the way these trials are designed and done."

Godlee also called for other reforms, including "far greater transparency from industry and the regulators, including access to raw data and funding for independent trials..."

Holding out a carrot in front of this stick, Godlee suggested that "the patent for new drugs should be extended, from the current 20 years to perhaps 25 or 30."

Personally, I don't think it's a good idea to extend the patent life by up to 50% for "greater transparency" by the drug industry. But Godlee is also calling for "funding for independent trials" as part of the deal. Is she talking about post-marketing trials like RECORD or the clinical trials upon which first approval for marketing is based? Where does the funding come from? I suppose she means that drug companies should somehow pay for "independent trials." That's going to be a problem even bigger than the problem of funding "independent" physician continuing medical education.

No matter how independent the pre-marketing trials are, the data are limited to a small population, which is often not representative of the population at large that will be exposed to the drug once it's on the market. That means additional studies may still be required after the drug is on the market to evaluate the safety among a larger population.

Perhaps having a drug on the market while additional studies are still underway is NOT as big a problem in Europe as it is in the U.S. where direct-to-consumer (DTC) advertising plays a big role in driving millions of consumers to their doctors to demand new medications. As online marketing begins to play a bigger role in marketing to consumers, this effect can be heightened. A recent study by About.com, for example, revealed that online health ads activate consumers as a result of seeing a healthcare (ie, drug) ad online:

• 44 percent researched medication in more detail as a result of seeing a healthcare ad online, up from 36 percent in 2009.
• 35 percent talked to their doctor after seeing an online healthcare ad.

IMHO, a better solution -- in the U.S. anyway -- might be to temporarily prohibit DTC advertising of drugs that require additional studies until those studies prove that the drugs are safe and effective as used in the marketplace. The carrot can still be an extended patent life as Godlee suggests. I have suggested this before -- see "Restrict DTC, but Extend the Patent for New Drugs" -- and the topic may arise again in my upcoming debate with DTC advocate Bob Ehrlich (see "The Great DTC Debate. Round 1: Are Drug Marketers an Endangered Species?").

My Journey From Obesity to Normal. First Stop: Stuck in Overweight!

Because of the long holiday weekend looming here in the U.S., I anticipate that today will be pretty slow. Therefore, it's a good time to record something personal and not offend my readers who may be looking for a "Mack Attack" such as the one I launched yesterday against Allergan, which I labeled an "unethical marketer and the the drug industry poster boy for off-label promotion" (see here). I guess most people started their vacations yesterday, because I didn't get any response to that attack.

Anyway, today I record here the first leg of my my journey from obesity to normal weight. The following chart shows my progress to date:

This chart was created by an iPad app that I am using to record my meals, weight and exercise history. The app is called "FatSecret." It syncs up with the FactSecret.com web site so that whenever I update data using the iPad, my Web account is also updated and vice versa. There's also a community, buddy system, etc. on the Web site, but I haven't used those social networking tools yet. That may change, however.

As you can see from this chart, I seem to be a bit stuck at my current weight of 191 lbs. My current body mass index (BMI) is 29.0. According to the National Heart Lung and Blood Institute's BMI calculator, that puts me out of the obesity range (BMI greater than 30.0), but at the high end of the overweight range (BMI = 25 to 29.9). To get into the normal BMI range of 18.5 to 24.9, I will have to lose another 27 lbs!

Since I am halfway there, I can look at this as a glass half empty or half full. Right now I feel half full, I can tell you that!

My goal, however, is to reach 175 lbs by the New Year. I am using the Numbers app on my iPad to plot my goal each month against my actual weight:

I missed my "goal" this month by 1 lb! Actually, I have been resetting the goal based on past performance. In August I reset the goal for the beginning of September to be 190 lbs. That's an 11 lb drop from the goal I set at the beginning of August (you can see the graph dropped steeply). I now have set my monthly weight loss goal to be about 4 lbs, which I hope is more realistic and attainable.

If you have any ideas how I can keep on schedule -- including some good low calorie recipes/meals, etc. -- let me know.

To those of you who have called me an "ass" or worse, thanks for not prefacing it with "fat"! When I lose that additional 27 lbs, nobody will be able to legitimately call me fat. I may, however, still be an ass!

"Reasonable" $600 MILLION Fine for Misbranding BOTOX: I Guess Allergan's Suit Against FDA Paid Off!

Allergan -- the company that markets Botox legally for wrinkles and illegally for other things -- agreed to pay $600 million in fines, including $375 million to the government as part of a Botox “misbranding” charge. Allergan admitted that its marketing of Botox from 2000 to 2005 led to intended use in treating headache, pain, muscle stiffness and juvenile cerebral palsy. Read the media stories and press releases here.

Considering that Eli Lilly paid $1.41 billion to settle charges that it had improperly marketed  Zyprexa for elderly patients with dementia and that Pfizer paid $2.3 billion to settle charges that it had illegally marketed the painkiller Bextra, the $600 million Allergan has to pay seems "reasonable," which is exactly how  Larry Biegelsen, an analyst at Wells Fargo Securities in New York, described it: “The $600 million settlement amount appears reasonable based on industry standards.”

Why such a "reasonable" settlement for a drug company that, IMHO, is an unethical marketer and the the drug industry poster boy for off-label promotion? Allergan, for example, has refused to abide by PhRMA's DTC Guidelines as well as PhRMA's Guidelines for Interactions with Healthcare Professionals (see "Allergan Doesn't Comply with PhRMA Guidelines, Wins Kudos Anyway"). Allergan has also been cited by the FDA for other violations such as a misleading Latisse Web site (see "FDA Reads My Blog: Declares Latisse Web Site Misleading").

You must read a bit further down in the media articles about this to learn that Allergan "is required as part of the agreement to drop the lawsuit it filed against the FDA in October challenging a government rule that prohibits marketing drugs for unapproved uses."

There's a lot to ponder when reading that statement.

I ponder, for example, whether Allergan got off much easier because it agreed to drop its suit? Which was probably frivolous to begin with!

BTW, I've written about Allergan's off-label migraine shenanigans previously. See Allergan's "Eye-popping" Migraine Botox Study: Freedom of Expression or Off-Label Promo Tool?

Allergan is currently seeking FDA approval of Botox for the treatment of migraine. In the above post I reviewed a clinical study that Allergan is doing to support its case. The drug was so ineffectual that the researchers admitted they “have searched for patient characteristics that may predict a favorable treatment response.” Of course, they ultimately were successful in winnowing down the migraine population that is responsive to treatment: ie, those people who suffer from "imploding" or "eye-popping" headaches but NOT "exploding" headaches.

This would all be a joke if Botox was not such a dangerous drug, which includes a black box warning on its label. But I won't get into that -- you can read what other people have to say about the dangers of Botox here.

P.S. As part of the agreement with the Justice Department, Allergan also will be required to publish information about its payments to doctors. I am not anticipating that Allergan's physician payment information will be easy to analyze considering that much more ethical drug companies have failed to be transparent in this regard (see "Transparency Vs. Translucency in Reporting Physician Payments").

Pharma Email Spam: Three Degrees of Separation for Merck, Pfizer, and Genentech

Soon after I posted a blog entry and tweeted about cholesterol-lowering drugs (see here), I "coincidentally" received the following e-mail message (click for an enlarged, readable view):

I do not remember opting in to receive email from Insyst Media -- the company that sent me this email. But, who knows, it may be one of those "third-party partners" of a website where I signed up to learn more about cholesterol.

So, naturally, I clicked on the "GET THE FACTS" button and was delivered to this intriguing Web page (click on image for an enlarged, more readable view):

Again,I don't recall opting in to any list maintained by  SearchNext, which is the company that seems responsible for this page. But being really curious where all this was leading, I obey and click on the button as indicated and end up on this page (click on image for an enlarged, more readable view):

Needless to say, I also never opted in to receive ads from FreshDeals.com --the entity that maintains this page. But I suspected that I was getting close to the sources who paid for all these companies to deliver ads to me. So I click on each ad on this page and discover that the top three links lead to pharmaceutical drug.com sites. One leads to Vytorin (Merck), another to Lipitor (Pfizer), and the third takes me to Zetia (also Merck). The last link goes to a Genentech non-branded site.

Following the Money Trail
I'm not interested in tracking down ALL these entities. I did, however, learn that SearchNext is a "pay-per-click advertiser marketplace [that] makes it easy to expand your already successful Google campaigns. Simply send us a dump of your AdWords campaigns and we will target your best converting keywords, geos and demos with our proprietary targeting and user qualification platform to turn users searching for your products into sales."

This "marketplace" conveniently puts 3 degrees of separation between the spam email I received and the pharmaceutical advertiser:

Pharmaco --- Fresh Deals --- SearchNext --- Insyst Media -- ME

I wonder if Merck, Pfizer, and Genentech realize that their Adword campaign is paying for spam e-mail? With 40% of pharma's online advertising budget allocated to search marketing, I can't imagine them NOT knowing!

Until All of Us Have This "Blue Button," the Online Health Revolution Has Not Even Begun!

Today I will listen to the BlogTalkRadio show "E-patients, Cyberchondriacs, and Why We Should Stop Calling Names," which promises to be an "open, honest and stimulating discussion" about the "potential implications of the use of the term e-Patient and why some argue that it should be reconsidered." As background to that discussion, see this blog post by Susannah Fox (@SusannahFox) who leads the Pew Internet & American Life Project's health research. Susannah will be a guest on the BlogTalkRadio show today and will be speaking at the e-Patient Connections 2010 conference next month in Philadelphia, PA.

In her post, Susannah says: "In short, the data -- Pew Internet's and others' -- are quite clear that the online health revolution is over and that use of digital tools in tackling health problems is the natural state of affairs."

I would argue that the online health revolution is no where near "over" just because the data shows that seeking health information online is now part of mainstream America (ie, 61% of American adults looked online for health information in the past year).

Seeking and FINDING credible, actionable, and personal health information online are TWO DIFFERENT things!

One piece of the online health revolution that has not yet occurred is the ability of the majority of Americans to easily access online their personal health information -- things like summaries of doctor visits, medications you are currently taking, or test results. I have been thinking about this recently. With diet and exercising -- something pharma marketers are often required to suggest in ads -- I recently lost 25 lbs. But my doctor told me my cholesterol is still too high. She wanted to prescribe a stronger cholesterol-lowering drug that I would have to take for the rest of my life, whereas one of my goals for losing weight was to stop taking this medication all together. What I wanted to know -- and what my physician didn't tell me -- was how my numbers compared pre and post weight loss. To get that information, I would have to go back to the doctor's office and ask her for the data. Why can't I just push a button in my Internet browser and get the data myself???

Yesterday, the Markle Foundation released a policy paper that said the ability for people to download their health records should be a priority in the nationwide push to upgrade health information technology. A public-private collaborative group of 46 providers, consumers, technology companies, insurers, and privacy advocates envisions a "blue button" as a common offering among secure websites for patients and beneficiaries by medical practices, hospitals, insurers, pharmacies, laboratories, and information services (see "Empowering the ePatient: A Simple "Blue Button" to Access Medical Records Online").

“By clicking the blue button, you could get your own health information electronically—things like summaries of doctor visits, medications you are currently taking, or test results. Being able to have your own electronic copies and share them as you need to with your doctors is a first step in truly enabling people to engage in their health care,” said Carol Diamond, MD, MPH, managing director at Markle.

Soon US Veterans will have such a "blue button" (see Blue Button: Download My Data): President Obama announced the blue button for veterans in an August 3 address. “For the first time ever, veterans will be able to go to the VA website, click a simple blue button and download or print your personal health records so you have them when you need them, and can share them with your doctors outside of the VA,” the President said.

IMHO, when ALL Americans have access to a "blue button" the online health revolution will truly have just BEGUN!

P.S. "Question to Ask Your Doctor": Where's My Blue Button?

After posting this, I saw a tweet from @AstraZenecaUS:

"September is National Cholesterol Education Month. See your doctor and visit http://ow.ly/2qo5v for a list of questions to ask."

This resolves to a page on the Crestor Web site. It just so happens that Crestor is the drug my doctor wants me to take instead of generic pravachol.

There are about 16 questions in AZ's list! Given that the average time a patient has with a physician during an office visit is maybe 10 minutes, that's about 38 seconds to ask each question and get an answer! Is AZ kidding? No wonder we don't remember what the physician told us!

One question that AZ left was "How can I get my personal health record online so that I remember all this and can use it?"

It's also amusing that AZ suggests you print out the pdf version of its list of questions and bring it with you to the doctor's office. How quaint! Shouldn't there be a "Share This With Your Physician" button on the page so that you can send the questions immediately to your physician before you even see her? Now that's when the online health revolution will truly begin here in the US!