In the midst of all this social media talk and the Internet being completely global, one of the essential aspects of effective healthcare delivery is often overlooked: the connection between clear communication and cultural background. When stakeholders come from different backgrounds, clear communication, and subsequently competent healthcare delivery may be hindered.

It is important to recognise that not everyone possesses Western views in relation to healthcare, illness, and treatments – both in the physical and spiritual sense, as the cultural backgrounds of patients can shape their views on the topic of well-being.

While a health belief model that attempted to explain patient behaviour in relation to cultural background was developed by social psychologists in the 1950s, it is important to explore the ways in which it is possible to predict and explain health behaviours in an era where digital health information is more widespread than ever.

Traditionally, studies on patient compliance are produced from a medicocentric perspective, where non-compliance is seen as a problem. If we consider non-compliance from a patient’s perspective, however, we may learn more about what motivates their actions. An anthropological study on patient attitudes towards drugs and illnesses concluded that non-compliance is rarely the result of patients misunderstanding the doctor but rather a result of them having different ideas and applying their rationality vis-à-vis the doctor’s. This rationality is comprised of political, economic, and social elements.

In the aforementioned study, Van der Geest, Whyte and Hardon concluded that especially in non-Western societies, pharmaceutical products are often recast in another knowledge system and used differently from the way they were intended in the regime of value where they were produced.

In order to exemplify just how relevant cultural background is from a patient’s perspective, we will take a look at a few examples.

According to a survey conducted by the Taiwanese Bureau of Health Promotion, up to one third of asthma sufferers in Taiwan do not take any kind of medication for the condition, and another third only use inhalers occasionally, or in the case of emergency, as opposed to taking long-term anti-inflammatory medication. A deeper look into Taiwan’s attitudes towards well-being reveals that almost 80% of asthma sufferers in Taiwan prefer to control their symptoms through a balanced diet and exercise, according to another article in The Taipei Times. Although the Taiwan Association of Asthma Education is encouraging sufferers to find out what their allergens are and take anti-allergy drugs, asthma is the 12^th leading cause of death among Taipei city residents and Hsu Shi-ta, director-general of the association states that it is often difficult to identify mild asthma symptoms, as they are viewed as ‘habitual’.

Another interesting example to consider, as presented in the study featured in the Annual review of Anthropology by Van der Geest, Whyte and Hardon, identifies a tendency towards what the author calls ‘defective modernisation’ in South-East Asia. This trend manifests itself through the belief that health is something one can obtain solely through the use of pharmaceuticals. A potential upside to this is the fact that commodification of medicine in the area means that patients have more choice and are able to put more pressure on healthcare providers by refusing a treatment.

Lastly, we will also look at how outlooks towards prescriptions can differ from region to region, also based on Van der Geest, Whyte and Hardon’s anthropological study.When medication is seen as the essence of the medical practice, prescribing is the main action that will be expected from the physician, perhaps serving as a legitimization of sickness. Whilst in some cases, not prescribing might be preferable on medical grounds, it is not rational according to cultural criteria and doctors might feel like they have to comply with patient demands. A refusal to prescribe may cast doubt over the genuineness of the patients’ complaint, so it can be said that in certain regions prescriptions serve a social and cultural logic. A written referral to a medical specialist may often serve the same purpose.

The concerns associated with this practice are many: it may lead to erratic buying of medicine, it might encourage patients to self-medicate by imitating the prescriptions they have received, and in poorer areas it might force patients to choose arbitrarily from the long list of medicines prescribed if they cannot afford them all (the cheapest one, the first one on the list, the one in stock, etc.)

All this being said, however, it is preferable not to make assumptions regarding an individual’s health beliefs based on their cultural background, as opposed to simply asking about their own understanding and concerns, advises the UK Health Protection Agency.

Conclusion

Although anecdotal, these examples show us that that understanding attitudes towards drugs should be a priority for pharmaceutical companies looking to launch a drug in emerging markets, as it is in these markets that one tends to be confronted with less conventional attitudes (at least from a Western viewpoint) towards illness and wellbeing. That is why deep local knowledge and market-tailored decisions are necessary to transform information into healthy behaviours. Patient-oriented analytics are also needed to extract meaningful intelligence from large amounts of information about populations and patients.

Creation Healthcare helps pharmaceutical marketers and communicators to translate insights about stakeholder behaviour into successful engagement strategies. With specialists in fifteen countries, Creation Healthcare supports global and regional strategy leaders, informed by local insights. To talk to us about how these insights can inform your international engagement strategies, click here.

We have previously looked at aspects of the drive to improve healthcare outcomes in Russia and considered channels such as telehealth, which are part of a wider governmental focus. Since 2005, $19 billion has been spent on improving the healthcare system and so far, various interventions and programmes have led to infant mortality  being reduced by a third, and life expectancy increasing by 3 years.

In parallel to this “Health 2020” agenda, President Medvedev has a “Pharma 2020” plan, which encourages domestic production of pharmaceuticals. Currently, Russia is reliant on imported products, and Medvedev hopes to change this, through investing in the establishment of “modern advanced enterprises”, capable of producing modern medicines.

To achieve these aims, partnership with foreign companies has been encouraged, and a number of key pharmaceutical players have started to get involved, setting up joint manufacturing plants with Russian companies. The latest partnership was between Aurobindo, an Indian company, and OJSC Diod, who have formed a joint venture, Aurospharma. The  focus will be on the provision of “socially significant” medicines to the Russian, Belarusian and Kazakh markets, and the plant will be ready for business in 2013.

Such ventures are likely to bring benefit to various stakeholders – the Russian population receives improved access to good quality pharmaceuticals, the Russian economy is boosted, and investors get to share in the significant growth of the local pharmaceutical market.

What role for emerging technologies?

Setting up a joint venture has its challenges though, particularly where the parent companies are based in different countries, meaning separate organisational cultures and employees who may not share a common language . However, it is critical that internal communication is efficient and able to add value.

Large pharmaceutical companies such as Pfizer, which have acquired various smaller companies, and which operate globally, have risen to this challenge through an increasingly social approach. As well as expanding the company’s social media presence externally, Pfizer has also updated its internal communications system, re-launching the Pfizer World intranet with a greater social focus. This is intended to improve communication throughout the company and encourage the generation of fresh ideas. Companies in other sectors are doing the same – innovation company Spigit specialises in providing internal social communication solutions to a variety of companies, and has served clients such as Lloyds TSB and AT&T.

Building on the social model, a number of pharmaceutical companies have adopted an “open sourcing” model to stimulate innovation whilst reducing the cost of R&D. Such a model could work well in Russia, to help overcome problems of geographical access and maximising the impact of the country’s scientific talent. Furthermore, Russia has been said to be experiencing a social media “boom”, with rapid and sustained growth of use. Twitter use grew three-fold in 2010 and the under-24 age group in Russia is the third largest user of “advanced mobile data” in the world. According to a Comscore survey that took place in 2010, Russians spend more time on social media sites than any other nation.

To assist with the language aspect of joint ventures, Google has a range of easy-to-use tools. Google Chrome has an inbuilt translation feature, and Google’s search engine also offers a user-friendly translation tool. Judgment is of course required when using such tools (in the example below, the Russian adjective “pharmaceutical” translates into the Hindi word for “drug”), but they may be of help in facilitating day-to-day communication.

Figure 1: Pharma2020 homepage - Google Chrome automatically suggests translation

Figure 2: Google translate. Here it translates the Russian adjective "pharmaceutical" into the Hindi word for “drug”

Conclusion

The Russian government is prioritising the nation’s health, and accordingly, the local pharmaceutical industry. As part of this, joint ventures between Russian and foreign companies are being set up. Emerging technologies may be of help in ensuring the smooth running of such ventures, and in facilitating the design and development of new products – particularly in Russia, where engagement via social media is strong.

Creation Healthcare helps pharmaceutical companies all around the world to perform better through improved colleague collaboration. To find out how we can help you, contact us.

No one wants to be wrong; ever. As much as there are trendy business mantras such as ‘Fail Fast’ which apparently encourage failure (as long as you learn quickly), it somehow just doesn’t translate to the world of a pharmaceutical company. In fact, ‘fail-fast’ is really an engineering concept that is most often considered in a research and development phase, long before a product reaches the general public where it might affect reputation.

To be fair, any kind of ‘failure’ in the world of pharmaceutical companies can potentially result in a significant loss in some form or another which could include shareholder value, customer confidence, or general credibility, not to mention individual careers.

Consequently, we are risk-averse. Rightly so.

As much as no individual wants to make a mistake generally, it is especially true that no one within a pharmaceutical company would want to be responsible for leading their organisation into a situation with negative outcomes. Each person will therefore look to innovate only within the realms of what is possible, rather than ‘push the envelope’ just for the sake of it or just because everyone else is apparently doing something.

Yet the rise of ‘social’ media has created an unusual scenario. On the one hand it seems safest to simply not do it at all. Yet on the other hand there is potentially an even greater risk by avoiding it, where a company is simply not able to participate, mitigate or mediate in a conversation when an incendiary or inflamed online situation gets out of control.

Adding to this, the fact that technology and online capabilities are constantly changing means that even when a ‘safe place’ is found within the social space, there is a reasonable chance that the ground may be moved underneath us. In the most notable of recent examples, Facebook have and will continue to introduce changes that cause speculation and reactive planning to cope with the implications.

So it may well be that quite a few people are losing sleep at night.

If you can relate to this unnerving state of change, then I would like to offer you some hope. The help of an external, independent, consultancy can help to alleviate some of the ‘what does this mean for me?’ or the ‘how are we going to deal with this?’

Creation Healthcare is on a daily basis partnering with lawyers, medical teams, communications teams, brand teams, and senior leadership to help formulate appropriate responses to the changing landscape. There is no pre-defined ‘right way’, but in each case a need for discovery.

Ultimately, we recognize that there is an element of risk in everything that we do.

It is however important to establish ‘what level of risk is acceptable?’, and ‘how do we minimize any risk?’ where the company may be exposed.

In reality, sometimes a company is just not able to cover the bases using internal resources alone.

For example, when considering a new digital initiative in a social platform like Facebook, is it really feasible that either a brand team, or the legal team, or the medical team, or anyone else within the company is in a position to comprehensively evaluate all the possible functional scenarios that may open the company to risk? Every back door needs to be explored, and someone needs to know whether there is an unconsidered exposure for any new step, or any change that happens after the initiative is in the public domain. Traditionally, the IT department may have been able to test security and standards for a company-hosted website prior to launch, yet as more initiatives move onto third party platforms they may no longer be the experts. It is simply not advisable to just ‘give it a try and see what happens’, as the ‘Fail Fast’ proponents may advocate.

When considering whether to use a third party or social networking site, a pharmaceutical company needs to be asking a much bigger internal question which might be phrased “Do we want to be social?” If so, “Will this loss of technology control cross a threshold of our agreed acceptable risk?”, and “Are we prepared internally to handle real-time processes that come with this risk?” All of these questions (and more) can be answered with time, research, thought and discussion, which can lead to a paradigm shift in the company culture.

Another consideration with this new era of communication is around whether a third party platform will even be around in years to come. Recent history shows that Google emerged as a global entity in only 4 years; MySpace.com fell from popularity; even Facebook is recently experiencing big traffic drops. There is no certainty about any of today’s major players, no matter how large and monopolising they may appear. Consequently, some companies are deciding to move their focus away from transients to commit to a risk/opportunity strategy around broader fundamental areas (such as search, video, networks, mobiles etc.) rather than platform specific areas (such as Google, Adwords, YouTube, Facebook, iPhone etc.).

Naturally any emerging platform, channel, or technology has an inherent ‘volatility’ which is born from not having experienced the thorough testing which comes with a critical mass. Twitter occasionally can’t handle the capacity that it needs, Facebook often launches a new feature without fully considering the implications. Google tends to have a lower ‘volatility’ due to more established testing protocols and having been in the market for a longer period of time. So a company needs to consider the ‘volatility’ when deciding whether an emerging channel is appropriate for their organisation.

Certainly, for a small amount of time it seemed that a new and rapidly growing audience could be reached through websites such as Facebook, and that a company could effectively host an otherwise standard ‘broadcast’ page around the company or a campaign – albeit in a social networking environment. Those days now seem numbered, as Facebook, Twitter, Google and others push new ‘social’ features which essentially change the way that the platform works, or affect the privacy, terms, and conditions. New questions arising from these changes about what is or isn’t within the control of the company, can make the difference between compliant communication and a breach of local regulations.

All of these considerations affect the inescapable ‘risk’. For a pharmaceutical company that risk can be a significant burden to bear. As new code guidance, policies, and regulations are brought in to address the changing landscape, this can potentially even heighten the sense of threat and reserve. In the United Kingdom this week, the industry body ABPI released a whitepaper which explains:

“…the complex regulatory requirements for pharmacovigilance, brought in to protect patients at a time of information scarcity, are now acting as a barrier to the use of this information as an important additional resource to protect public health”

Wouldn’t it bring peace of mind to know that there are people that really care about you getting it right? That they also don’t want you to have the proverbial ‘egg on your face’? That they want you to succeed, in an appropriate and measured way?

This is what Creation Healthcare consultants do every day. We are not lawyers, we are not ‘technical geeks’, we are not publicists or communicators. We are strategists, with a pedantic insistence on doing things in the most considered way possible – according to legal guidance, according to what is best for the client, and according to what may be best for the people that are interested in what the client is offering.

Creation Healthcare is a specialist consultancy working with executive and cross-functional teams in pharmaceutical companies. For assistance with assessing and managing risk, or to better understand appropriate engagement strategies for your company, contact us on +44 (0)207 849 3167 to arrange a confidential meeting.

When it comes to targeting healthcare professionals, physician social networks provide a valuable resource for studying the behaviour of doctors, and engaging them in relevant and well-targeted ways. However, the sheer number of physician networks, and the range of capabilities, can make for complex strategy planning and implementation across international regions.

Today, however, a brand new service has been announced that allows pharmaceutical companies and healthcare organizations to research and engage healthcare professionals in eight European countries, promising ‘integrated programme management and measurement’.

Networks in Health is an alliance between Europe’s largest online physician communities: the UK’s Doctors.net.uk; France’s Egora and La Revue du Practicien; Medcenter in Spain and Portugal; coliquio in Germany, Austria and Switzerland; and Sweden’s MedUniverse. The combined network represents over 600,000 registered physicians.

Networks in Health Development Director, Gareth Thomas, says that the immediate benefits for organizations seeking to engage physicians across Europe are the consistency of approach and the ability to measure across all the networks centrally.

“We can provide real insights – not just quantitative; we can track user journeys so we know which kinds of doctors are engaging with content and how. But also, all these communities have some form of discussion forum, so there is a huge amount of knowledge about what doctors are talking about and how they’re behaving and interacting with online content.

“Through the market research and analysis tools that we have, we can provide insights back to customers pre, during, and post programme, to see the impact of what they are doing.”

Cultural diversity

An essential factor in pan-European healthcare engagement is the need to incorporate local cultural and language insights into a regional strategy. Networks in Health has been launched with this in mind – Thomas says that the power of the alliance is that it is not a ‘one size fits all’ international network but recognises the diversity that exists between individual countries, languages and cultures: “The strength that each partner brings to the alliance is not only the reach to their members, but also local understanding and knowhow of market standards, culture and regulation.”

All the communities that make up Networks in Health use fully-authenticated membership, making the network a unique international platform to engage a community known to comprise solely registered doctors. This is especially important for pharmaceutical companies operating in Europe, where direct-to-consumer marketing of medicines is forbidden.

Centralised analysis

Networks in Health analysis tool
(source: http://networksinhealth.com/reporting-analysis-insight.html)

Networks in Health provides a single point from which to launch and deploy a physician engagement initiative across any of the member communities, and provides centralised measurement.

“On the quantitative side, we will provide real-time dashboards to regional and local brand teams so they can compare the results of campaigns, and can see which messaging is resonating  in real-time between markets”, says Thomas.

Creation Healthcare’s Elite Global Forum was conceived to be a no-nonsense, no-limits, global think tank. Since that time, several informal discussions have been taking place around the globe in which professionals from pharmaceutical, hospital, government and not-for-profit organizations challenge each other, share ideas, and look to break new ground in healthcare engagement.

While attending conferences in New York, London, and Munich during the early part of this year (see where we’ll be next here), Creation Healthcare spent time interviewing just a few of these thought-leaders. The resulting conversations provided many fascinating insights into the rapidly changing communications landscape, which is maturing to some extent.

These strategists and corporate communications professionals were quick to recognise the opportunity and potential threats of ‘Social media’ and were themselves early adopters and innovators in healthcare with two-way communication.

For many of them the questions about ‘whether to be involved’ have been answered; as have the questions of ‘how’ to be involved. Their greater challenge – at the fore front of their mind – is bringing these changes to the company as a whole, and the increasing importance of senior management ‘buy-in’ to bring true organisational or cultural change.

In the following video you can hear about ‘Cultural change in a digital world’, and in the coming weeks and months we will release other videos on topics including:

• the role of pharmaceutical companies in online conversation
• building trust and reputation
• the rise of the e-Patient
• building strong partnerships
• the challenges that the industry must overcome to face the future

Figen Samdanci of Pfizer Turkey starts by explaining that “Change begins internally” and that you need to know your company well to be able to make a case for ‘why’ the communications strategy is evolving into new platforms. She points out that ‘support from executives’ is important.

Alex Butler of Janssen suggested that 75-80% of his job is ‘internal’ and necessitates helping the business to understand ‘what it takes culturally’ to enable projects across the various functions of the company which keep pace with consumer expectations. Marc Monseau agrees:

“What you really need in an organisation is to have people in senior management roles who are supportive of making these things happen… …to support us in being able to make mistakes, but also to see the value in the long-term for the function…”

Google’s Amy Cowan believes companies ‘focused on innovation and on their patients, will benefit and lead the pack’. Jens Monsees feels that there is still a lack of clear vision in many companies.

“…there are a lot of people struggling by saying what they actually want to achieve. If they are not knowing where to go, then they are going nowhere…”

For some companies, the impact of change and the lack of certainty about how to navigate uncharted waters means that they could be tempted to return to old established business models, particularly around pharmaceutical sales reps. Yet Ray Chepesiuk of PAAB Canada suggested that sales reps need a new role – to be more like medical science liaisons – in ‘places where and when the doctors want them to be.’ He even thinks reps should be online ‘virtual sales reps’.

The core of the business model for pharmaceutical companies is changing as much as the communications channels are. Expressions like ‘Beyond the pill’ do reflect the need to provide more than a medicine, and Brian Dolan is watching companies like Vitality who make the ‘GlowCaps’ range of adherence products. With greater than 99% adherence, this can make a huge impact on the bottom line, beyond the point of prescription.

Whilst improving adherence means improving return on investment, Alex Butler points out that there are many communications activities which are important but are not necessarily about making money directly.

“We’d always produce disease information campaigns; not that long ago it would be leaflets, pamphlets or this, that and the other. What return on investment did we ever prove with that? Whereas now we can show how many people use something; we can understand what that might mean or whether they might go to the doctor with that…”

There are a growing number of brand managers and product leaders that are ‘digital heroes’, in Jens Monsees opinion, yet he goes on to say:

“We observe in the moment that there is no overall company strategy within ‘Big Pharma’ that is actually focusing on digital, and on leveraging this huge potential.”

Marc Monseau leaves some final insight that social media ‘is a tactic which supports a broader strategy’. He refers to the ‘online face of the company’ which needs to be consistent across all channels:

“Social Media in and of itself does not sit to one side, but is part of a more integrated approach”.

To speak with one of our consultant team, please contact us now and we will be pleased to further understand the challenges that you may be facing around cultural change in your organisation.

If you are a business leader or communicator in healthcare, you can get your free subscription to the Healthcare Engagement Strategy e-Journal at http://engagementstrategy.tv/

A study by Creation Healthcare into engagement amongst pharmaceutical companies in Japan reveals a significant trend emerging towards digital channels and social media, in what has until now been a traditionally conservative environment.

In partnership with Eyeforpharma, Creation Healthcare‘s research surveyed senior marketers, communicators and executives amongst the Japanese pharmaceutical and healthcare industry. The goal of this research was to provide insights into the evolution of digital communications channels in healthcare engagement in Japan.

Creation Healthcare will present the full results of this research in Tokyo at the 4^th Annual Marketing Excellence Japan 2011 Conference, which takes place May 17-18 2011, where we will outline digital engagement trends we discovered amongst Japanese pharmaceutical companies. In this article we will present some of the trends that we will discuss in full during the event.

Insights from Japanese Pharmaceutical companies

Responses from professionals in pharmaceutical companies in Japan to an online survey developed by Creation Healthcare with Eyeforpharma provide a clear picture of trends in the current use of digital platforms and channels, highlighting the challenges faced internally to implement digital projects and forecasting changes in future budget expenditures across communications channels.

The research also reveals participants’ perceptions about the evolution of the relationship between patients and doctors in Japan. Participants shared interesting responses about how their industry could use social media to connect better with patients, and the kind of outcomes that companies are looking for from such initiatives.

Budget priorities

The research indicates some clear changes in pharmaceutical companies’ budget spend between “old” and “new” channels, with a trend towards an increasing allocation of budget to digital, much as we have already seen in the European and US markets. In the presentation of our results, we will outline in detail which channels will attract the most significant budget increases and decreases.

Budget trends will be presented in Tokyo

Creation Healthcare’s presentation in Tokyo will cover the following areas:

Awareness

We will show which digital channels are being used now or being planned for the future; and we will provide a picture of the social media platforms currently used by Japanese pharmaceutical companies and the extent to which they are being used to communicate with different stakeholders.

Challenges

Whilst social media and other emerging channels of communication open many opportunities for healthcare and pharmaceutical companies, the heavily regulated pharmaceutical environment has the potential to raise new challenges with every new channel. We will present insights into the most important challenges faced by Japanese professionals in implementing digital projects.

Top social media engagement pharmaceutical companies in Japan

Respondents told us which pharmaceutical companies they most admire for their effective use of social media in Japan. We will share the top pharmaceutical companies as ranked by their peers.

Future

Finally, the research presentation will look to the future and outline respondents’ vision for the evolution of the use of social media in healthcare in Japan, including details of how channels will be prioritised in future Japanese pharmaceutical engagement strategies.

To find out more about these insights into digital trends in the Japanese market, meet us at 4^th Annual Marketing Excellence Japan 2011 in Tokyo or get in touch now.



It was ironically only a couple of weeks ago that Creation Healthcare published a piece about “Healthcare engagement in the absence of regulatory guidance”. In that article, I made the point that “specific social media guidance cannot keep pace with change”, and more importantly that when using 3^rd party engagement platforms like Facebook, Flickr or Twitter, a pharmaceutical company needs to ‘plan for change’.

In what I perceive as a positive step, the PMCPA recently issued guidance on ‘Digital Communications’. I was pleasantly surprised to see a certain level of clarity and an attempt to be non-technology specific. I still felt that in some cases it was too specific, which I will explain as you read on.

Even so, the inevitable ‘What does it mean for me?’ has me once again turning to interpretation and best intent, rather than an exact rule of law that some have called for.

A ‘forum’ for debate

For pharmaceutical companies, the most significant lines in the new guidance, in my opinion, can be found in Guidance 4 (p 6) where we see the words “Can companies run discussion forums?” and:

“Before undertaking such an activity the company must be confident that it can moderate the site such that the only content to appear complies with the Code”.

You may at first think, “Well that is fine; we are not running a forum”.

Yet so many 3^rd party platforms are perhaps not technically described as a ‘forum’, yet have the characteristics of one. Consider Facebook, Twitter, Flickr, or indeed any place where it is possible to submit user-generated content in some form or another. The main difference between them is the speed of response between participants.

Some platforms may not even be designed with two-way conversation in mind – instead to merely provide a means for a person to comment – yet when used in a particular way can certainly become conversational, albeit not in real-time.

The real issue here is not whether it is a forum or not, but the fact that people can enter free-text.

Free text creates the possibility for a range of potentially problematic content, such as: mentions of brand names which might be construed as promotional content (intentional or otherwise); discussions about off-label use of medicines; or spontaneous Adverse Event reports.

I would suggest as a general thought that the PMCPA might want to change some of the technology specific terminology like ‘forum’ to a broader description around a ‘text submission’. By all means, they may wish to illustrate the point with examples of specific technologies (like Twitter, Facebook etc.) however the guidance itself should ideally not be so tightly defined.

That said, let’s now consider the second part of Guidance 4 “…the only content to appear complies with the Code”.

Reading the guidance here (in the ‘spirit of the code’) has major implications for current and future Pharmaceutical communications activities. Here is the gist in my interpretation:

Content MUST be pre-moderated.

‘Pre’ versus ‘Post’ versus ‘Both’

Until now, some pharmaceutical companies have used ‘best intent’ and ‘due diligence’ to implement strategies and processes that accommodate the constraints of some 3^rd party platforms such as inability to pre-moderate user generated content.

If the new guidance really does clarify that all content must be pre-moderated, I predict that in the place of some currently innovative pharmaceutical communication initiatives, you will see a return to company controlled dedicated websites with built-in functionality for moderation. You may even see many companies move away from social media altogether.

It may well be a step backwards from ‘fishing where the fish are’, but will also call for new ‘innovation born from adversity’. I’ve always believed that the very best creativity comes when there are constraints. Like the artist with only three colours in her palette, or the architect with a limited material selection, there is always a solution. Conversely, give an artist unlimited budget and unlimited time, and you don’t often see something of artistic merit.

So, moderation is the one big element of the guidance which has me really thinking. From my perspective the moderation issue is not quite ‘black and white’. There is quite a bit of ‘grey’.

The extent of this issue

Let’s consider some examples of this ‘greyness’ in context:

Have you created a Facebook page? Perhaps you decided not to open the wall for comments, to prevent user-generated content. Well, let’s say someone has gone ahead and ‘Liked’ your page and thanks to Facebook’s new image gallery on pages (launched March 11), decides to click on an image. There they discover that they can add comments to the images within the gallery. If your pharmaceutical company is monitoring this, any non-code compliant comments may be deleted; yet this would be a post-moderated step that only happens at the point of awareness of the comment.

Facebook has and is likely to continue to move its platform away from simply ‘hosting’ product or awareness pages, forcing conversational features on page owners.

Perhaps you have enabled Facebook’s new word filter and listed all of your product names in there to avoid any unwanted brand mentions? Yet let’s assume that someone enters a comment on your wall and has not spelled your product name correctly. It has made it through the moderation filter and you now need to delete it. Once again, post-moderation is required.

What about the clever pre-populated sharing tools that are on a website? If a pharmaceutical company provides a means for a user to share a website or content about a campaign, that user can modify the final submission in keeping with their own message; yet the pharmaceutical company cannot moderate this. Whether the company is responsible or not is likely to depend on a number of factors including whether such shared comments appear on any platforms hosted, managed or endorsed by them. Of course a person can also share content of their own accord, using their own preferred sharing tool.

Responsibility

In many ways, it is the ‘responsibility of ownership’ which truly defines what is or isn’t possible.

What is made very clear through the new guidance is the extent to which a pharmaceutical company is responsible for content when on 3^rd party websites, and indeed on sponsored websites (See Guidance 5, pg 7). The definition of “arm’s length” and ‘unrestricted grant’ really does show that the only way that a company is not responsible for the ongoing activities of a sponsored website is if it does not ‘initiate the material, or the concept for it’; that is has no ‘influence’ on the material, and that it does not ‘promote the social media site in anyway unless all of the content complies with the Code’.

I’m not saying that any pharmaceutical company would knowingly sponsor a site which promotes prescription-only products. However, by sponsoring a site it appears to me that the Code requires the pharmaceutical company to indefinitely be aware of the content on that site; even if the recipient of the grant or sponsorship has breached the Code at a much later date.

This raises one of the evolving considerations for pharmaceutical companies in digital communication. What is the true cost of ownership of a social media campaign? At what point in time is it no longer an obligation? Are we forever committed if we engage with the public?

This new guidance is likely to accelerate the pace of change within pharmaceutical brand and communications teams, as they look to increase capacity and skillsets for keeping abreast of all that is happening in the digital space across multiple digital properties.

Where to from here?

Certainly, we are all navigating in uncharted territory. I believe that as an industry we really want to do the ‘right’ and ‘best’ thing for our customers. Yes, I did say ‘customers’.

The PMCPA, the ABPI, the FDA, and the many Pharmaceutical companies who are trying to meet the customer on their ground, still have a long way to go before the customer receives anything like the level of engagement which they are used to from other industries and which they expect in regard to their own personal health information needs.

I can’t help feeling that the various attempts to understand, describe, and provide boundaries for changing communication platforms is making this all much more complicated than it need be. I also wonder if the guidance could instead be summed up in one sentence:

If you are a pharmaceutical company in Europe, don’t inappropriately promote your prescription-only products through digital, or any other channels.

In the world of emerging digital channels, pharmaceutical companies would then be free to adapt to the changing landscape and innovate in a regulatory-compliant manner.

In the complex world of healthcare engagement, the role of key opinion leaders (KOLs) in influencing the behavior of healthcare professionals is becoming increasingly important. And as with any healthcare engagement strategy, there is more to working with key opinion leaders than simply adding another channel to the mix.

Why consider KOLs?

With so many new ways of connecting with and influencing healthcare professionals, why consider working with KOLs at all? If you are responsible for a pharmaceutical product then I would suggest the primary answer to this is quite simple: doctors trust each other (more than they trust pharma).

The effect of this is seen in the growth of physician-only networks over the past decade. Doctors on these networks talk about anything from clinical matters to all kinds of topics completely unrelated to their professional lives. The reason for this is simple – the mutual respect that exists amongst healthcare professionals for the opinion of their peers.

Another good reason is that experts add credibility in a time-constrained world. Of course a good KOL is not necessarily a healthcare professional, but they must certainly be a credible, trusted expert. It is quite possible that the trusted experts you choose to collaborate with as KOLs will find it easier to gain the ear (whether in published form, via doctors’ networks, at conferences, or via any other channel) of other healthcare professionals than your medical sales team will.

Five questions to start your KOL strategy

As an example of the role of KOLs, consider the launch of a new pharmaceutical product. As a component of your engagement strategy, KOLs could have a significant impact upon the success of the launch. Yet without the right approach, significant resources may be wasted by everybody.

Some simple questions to ask yourself when developing a KOL strategy include:

1. Why are KOLs important to us?
2. What do we want them to do?
3. How will we support them in achieving our goals?
4. How will we define and measure success?
5. Who do we want to engage (which experts should be our KOLs)?

Understanding influence

In order to identify and prioritise the right key opinion leaders, it is worthwhile understanding the relative impact of any professional or expert on their peers. Here are three areas to consider:

• Connectedness: How well connected is the KOL with their peers?
• Expertise: Is the KOL known as a leading expert in a particular therapy area relevant to your product?
• Credibility: Credibility is likely to be a function of connectedness and expertise, and may be measured by examining the effect of the KOL’s activity on others in the past.

Learn from your peers

Creation Healthcare’s publication for leaders in healthcare, Healthcare Engagement Strategy, is partnering with KOL & Stakeholder Engagement Europe conference which takes place in Berlin, 4-5 May 2011. As a reader, we are delighted to offer you a discount of €300 to attend the event. Simply book your place using code ‘CREATION’.

Meanwhile, for confidential advice about integrating emerging healthcare engagement channels into your business goals, contact Daniel Ghinn on +44 (0)207 849 3167.

Less than three weeks after a Facebook page was set up by one patient angry with KV Pharmaceuticals’ pricing of its newly approved drug Makena, the US Food and Drug Administration (FDA) has today announced that KV should not have exclusive rights to produce similar products. This apparent about-turn resulted in the pharmaceutical company’s share price plummeting, placing it at the top of the NYSE Biggest Percentage Decliners list with a more than 20% drop in share value.

Prior to today’s FDA announcement, KV Pharmaceuticals had been granted seven years of exclusivity under the Orphan Drug Act and received what the FDA describes as ‘considerable assistance from the federal government in connection with the development of Makena’.

After the product was approved on March 10, KV Pharmaceuticals sent letters to pharmacists, many of whom had previously been able to compound their own versions of the drug, warning them that they faced potential FDA enforcement and should stop compounding the drug themselves.

However, the FDA’s announcement today makes it clear that this is not correct but rather that “the FDA does not intend to take enforcement action against pharmacies that compound [the active ingredient] based on a valid prescription.”

On 17 March, one week after the FDA’s approval of Makena, Creation Healthcare reported the launch of a Facebook page by pregnant mothers in the USA angry about KV Pharmaceuticals’ pricing of its newly FDA-approved synthetic progesterone product, and raised once again the urgent need for pharmaceutical companies to plan ahead for social media engagement.

At the time, the Facebook page had already reached over 550 fans. By today, 30 March, that number was over 1,400. It is not merely the number of fans that is notable, however, but their level of engagement. The page’s wall is rich with comments and links to external resources. And the Page’s ‘Photos’ area has become a powerful visual gallery of children and newborn babies.

The Facebook page’s ‘photos’ area has become a powerful gallery of newborn babies.

I asked Christine O’Connell, the Facebook page’s founder, today about the role of Facebook in the campaign to rally support. She told me that it provided the best platform to reach many people quickly and share ideas:

“I started this page quite simply because I was outraged. I knew if other people knew about this unconscionable price increase, they’d be outraged too. Facebook gave me the best platform to reach a lot of people in a short time.

“My hope was that we’d stir up enough public anger to somehow force KV Pharm to right this wrong. I wasn’t sure how the page could achieve that, but I believed that if we put our heads together, we’d figure something out.

“And that’s exactly what happened. Not only did affected moms and dads get involved, but doctors, news reporters and medical organizations joined the conversation. We shared information and ideas on everything from boycotts to contacting our Congressional representatives.

“I really think this was the power of social media to inform, educate and rally people at its best!  I’m so pleased that common sense has prevailed.”

The response from members of the page’s ‘community’ of supporters is perhaps best summed up by this comment from one of them:

“I just want to say THANK YOU for starting this page. I joined when there were under 100 of us, and now look! Not only is it a voice for women and their future babies, but we have seen well respected doctors engage in this conversation a well as health organizations. It has proven to be a powerful tool.”

So whilst the FDA continues to ponder the pharmaceutical industry’s role in social media, perhaps this story will remind those working in pharma communications that failure to engage with patients online today is simply not a viable option.

In essence, we are mobile and arguably much more today than ever before. And in the connected world in which we live, we want to have access to the same services during our “mobile day” that we do at work or at home.

Devices such as the iPhone and the iPad opened new ways to stay connected to all the knowledge that the Internet gives us access to. Moreover they allow people to always stay in touch with their online communities, by having multiple screen access to their favourite social media platforms or communities.

In the healthcare industry, new ways of using mobile devices, and changes in user behaviour, will continue to give us lots of new opportunities to engage with different stakeholders. At the same time, they will give us the chance to improve the way we are communicating, marketing and planning our businesses.

Mobile: are you ready?

Before looking at these opportunities, we need to understand and be prepared to embrace the actual evolution of our environment. Today, when we talk about mobile it is easy to primarily think about Apps, the iPad, and all new ‘geeky’ devices or services. Of course, such tools have to be taken into account but firstly we need to think about our existing content and platforms whilst we are looking for new ways to engage with our customers.

Indeed, although new apps are continually emerging, a large part of the mobile use of Internet is made through mobile browsers and search engines such as Google. This means that lots of people are trying to access to your website via their smartphones or tablets (and increasingly so in the near future). But are you ready for this simple way that people are using to access to your content?

If I ask this question, it’s because I’ve been reviewing lots of pharmaceutical companies’ campaign websites on my phone (iPhone 4). Many of the sites did not work well, for reasons including use of Flash content which currently cannot be displayed on an iPhone. On some, only parts of the website were not accessible and others delivered a very poor mobile experience. Beyond this access problem, this means that if you have invested in promoting your campaign website, such as through a Google Adwords campaign, you will probably lose money because many of the people you drive to your site will not be able to see any content. Moreover, this bad experience can even potentially have a negative effect on the brand or the company perception and finally suits your competitors.

So, in an environment where people are switching from desktop to mobile access to the Internet, this has to be taken into account to optimize your ROI and ensure you are providing the same quality of experience to all your costumers, wherever they are.

The year of mobile, really?

“2011 is the Year of Mobile”, this sentence has been said and heard a lot in the first months of this year, referring to the extensive adoption of mobile devices as a preferred Internet access tool. Indeed, the trends show us that people are increasingly using their mobile devices to access to the internet and use the large range of services it allows (video, sms, games, localization, augmented reality, etc.).

To go beyond, I would say that it is probably incorrect to keep talking about a “Year of Mobile”, since this was also said about last year and we will probably hear it next year too. In fact, we are in an “Era of Mobile” which started in 2007 with the first iPhone and is still only emerging. Mobile is the junction between the digital world and the “real” world which will soon simply be the world, that’s why it is essential to be prepared for it.

Mobile: 4 recommendations

As I said before, smartphones have started the mobile era. As a consequence, the development of services through applications on smartphones for healthcare professionals or patients is becoming natural for pharmaceutical companies. Of course, the iPhone is the mobile platform of choice to reach early adopters, but the massive growth of Android OS together with the arrival of Windows Phone OS is changing the mobile landscape and making it more complex.

The growing complexity of the mobile era is making decisions about channel choice much harder than they were before, not only because of the different OS systems  (iOS, Android OS, BlackBerry OS, RIM, etc.) but also variables such as the technical specifications of devices, tablets and the numerous Stores, just to name a few. It is important to make the right choices to maximise effective use of budgets to reach your goals.

To make the best choices, I will give you a few recommendations:

1. Look at where your customers are and which devices they use

This will help you to prioritize your choices. Make sure that you are developing services on the right OS for your audience (e.g. Android will probably be the good platform to reach a massive number of people in addition to iOS, and for now iOS is certainly the best platform to provide services or engage with doctors).

2. Think of when your customers are using mobile devices, and how

Laptops, smartphones and tablets are not used in the same way, at the same time of the day and in the same places. Those parameters have to be taken into account when you are designing your strategy. In fact, the ”mobile day” of your customers is divided into different phases, such as using their smartphone in the morning, their laptop during the day to work with and maybe their iPad in the evening to relax on their sofa or in their bed. This example shows us that the user’s needs, and the level of engagement you can reach through the different devices, will vary throughout the day and are likely to affect the impact of your communication.

3. Measure your results

Measuring your results is one of the most important parts of your strategy. Indeed, this will give you assets to improve your project and better understand your customers. Often, the success of mobile projects (e.g. launching an app) is measured with the number of downloads of the app, but if you really want to know if your goals have been reached, you need to look deeper. The number of downloads does not mean a lot if your goal is to engage people because most people download an app to see how it is, if it’s interesting, etc. Information such as the regularity of use, the time spent on the app, the traffic driven to the main website and so on are true indicators, and once analysed they can provide real insights to learn from and improve your strategy.

4. Think long term

The micro-environment you are creating for your costumers has to be thought through in the long term. Technically, the platforms, the devices and the digital environment itself is moving fast and you have to be able to provide an updated service. Strategically, the move from “one shot campaigns” to “long term engagement” is hard work because it needs changes in people and organizations mindsets, but it is the way to create real relationships between your brand, your company and your stakeholders.

What next?

Mobile is changing the world we are living in. Beyond the fact that mobile allows access to the Internet, mobile is facilitating the input of information thanks to the growing number of sensors present in our devices and the birth of  ‘Internet of objects’, where everyday objects are connected to the Internet. The emergence of IPv6 (next generation of the internet protocol) will open the next mobile revolution. Objects such as household appliances will have a unique IP address and will be able to communicate with the ‘cloud’ and vice versa.

The WiFi body scale you can see below, automatically transfers information to the cloud to allow people to access to it wherever they are, whenever they want and to share it with their doctor, nutritionist, online community (e.g. Lose it!) or personal health record (PHR) system such as Google Health or Microsoft HealthVault.

A connected weighing machine from Withings

This will change the way we are interacting with the physical world and will continue to merge the real and digital world. The data coming both from us and from our environment will be phenomenal and will help to inform and engage the next generation of healthcare stakeholders.

Creation Healthcare provides trusted healthcare engagement strategy advice to pharmaceutical companies and healthcare organizations. For a confidential discussion about engaging your customers and stakeholders using emerging technologies, contact us.