Social Media and Health Care Marketing ... an MBA Master Thesis ...

Long time no see ... well I've been busy finishing my Master Thesis, but now it is finally done. I will post part of it in separate articles, but for those who want to read it completely, here is the pdf.

Please let me know if you have any questions or comments or if you see anything incorrect

The characteristics of Social Media

First of All a MindMap which gather most of the ideas ... and often a picture is better than a long text ...

For those who like ling text it is below

The Key differences between traditional marketing and Social Media marketing:

Content is everything

Obtrusive advertizing doesn’t work within Social Media because the consumer is in charge of the agenda. In order to get a message through, to the consumer, a company has to provide added value. Consumers are not looking to increase their awareness about a product, and in general, increasing awareness is not an approach that someone can adopt pro-actively. Increasing awareness comes from the repeated exposure to a message and it is a passive process. Social Media require consumers’ involvement and participation. As Jimmy Maymann points-out: when a billion consumers add their content and creativity, the passive consumer becomes an active user, thus the advertisers needs to evolve from “push campaigns” to interactive campaigns. Pop-ups and websites where advertising are too dominant will drive users away, when they are not blocked automatically by the web browser. According to ABC Studios’ president, Mark Pedowith: “Digital Media has leveled the playing field, opening doors for anyone to have immediate and unlimited access to an audience. But content must evolve with the platform” [MAYMA08, p.11]. The questions that advertisers, ultimately need to answer are: “why would I click on this link?” or “why would I watch this video?”, and the next question “would I send or recommend it to my friends”?

Social Media relies on strong values

There are countless examples of companies making the headlines because of their unethical behavior or because the message they are sending is considered by some as offending. Recent examples included BP’s handling of the Mexico’s Gulf oil leakage. BP purchased several key words including “oil spill” with the major search engines, in an attempt to promote their cleaning efforts, but the effect was the exact opposite and people had the impression that BP was trying to polish its image rather than cleaning the soiled beaches [BUSKI10]. Social Media advertising is about authenticity and honesty, if users believe that a company is trying to use them or is lying to them, then the backlash will be brutal. Transparency and honesty are other key values of Social Media [JILG10]. People don’t want to be fooled, especially when they look for recommendation or read a review, hence if a company is trying to promote its own products by faking good reviews, the negative effect will be dramatic. It is also important for companies starting to use Social Media to be humble. Consumers were using Social Media much before most companies even knew about their existence, therefore companies shouldn’t behave as if they new the ins- and outs- of Social Media, they should be respectful of the user and act responsibly. Not allowing people to post a comment will, for instance, send a very negative message to the users, it will sound as if the company is using Social Media as a bill-board or a corporate advertising in disguise; worst, removing comments will be compare to censorship, which will eventually be revealed. Finally, Social Media are about mutual trust. This is what a company should aim for. Social Media are a great tool for spreading a message, but they are also a great tool for listening to consumers. Showing that their concerned have a spot on the corporate agenda, and addressing their concerns in a pro-active manner is the best attitude that company can adopt [MAY10].

A new set of relationships

Social Media redefine the relationships’ between companies and customers. In the era of push marketing, companies didn’t really have to listen to the customers, now they have no choice, because customers have the tools to spread their messages to the world. Companies, whether they like it or not, have to engage into conversations. There is a greater proximity between the customer and the brand, therefore a direct conversation is possible, this is what happens on forums for instance; from a consumer perspective, this an opportunity to get specific request or questions directly to the brand and from a company perspective, this is an opportunity to get “unfiltered” customer feedback. But conversations do not start only with companies, they also start among customers, this is an opportunity as well as a challenge for any companies. Rupert Murdoch, NewsCorp’s CEO, said: “Media companies don’t control the conversation anymore” [MAYMA08, p.8]. Apple, better than many companies, understood that consumers acting as brand advocate are more efficient than the best sales men at promoting a brand and its no surprise to see that the company performances are rising while at the same time it’s also one of the most discussed-about brand on the cyberspace. Electronic-Word-of-Mouth (eWOM), in the digital era, is playing similar role than the 1950s Word-of-Mouth (WOM) when it was first studied by Whyte and William, to analyze the spread of air conditioning installation in American neighborhoods [WHYTE54]. The difference between WOM and eWOM is the scale, while in the 1950s it was limited to a small circle of friends or family, a positive (or negative) experience can now be communicated to the world [HENNI04]. In the digital world, authority doesn’t arise solely because of someone power or wealth, as we saw above, customers and corporations can express themselves on the same level, we therefore observe an equalization among authorities, and to push this concept even further: customers become the new authorities. Someone, who is an expert in a topic, will be able to gather fans (Facebook) or followers (Twitter) who will be exposed to what this person has to say, and who will spread the message within their social networks. Those people are referred-to as electronic Key Opinion Leaders (eKOL) or e-Fluencers [WATTS07], [KELLE03], [BURSO08]. According to Peter May, platform manager at Vodafone, companies should nurture special relationship with them in order to spread company’s information in the online world. They have a public that can often not be reached using traditional media [MAY10]. In a sense the digital world is a democracy, and authority emerges because of someone’s engagement and peer’s recognition.

Everyone’s a producer?

Some of the most successful video on YouTube have been posted by amateurs. This example outline that fact that production quality is not the main requirement to be successful on the Web, as we said earlier, content is premium [PRIES10] and as long as it is good, the message will spread among the users. Some Social Media experts will even advocate for “unprofessional” content, because the user might feel closer to the message that is being carried. Another characteristic of Social Media is the decentralization and collaborative process of production. This is of course facilitated by digital tools, everyone can contribute to the production of a video for instance, there are even examples of live concert on YouTube where the musicians met and formed their band online. Despite the fact that everyone can contribute to content production, the fact is that users can be classified in three categories regarding content production (see Picture 3, Appendix, p.53), they are either just looking for, or, sharing information and therefore not producing anything, or active producers; but the share of active producer is rather limited [CHENG09] & [HEIL09].

Dynamic distribution channels

How to get your message across to your customers? This is a basic question that most marketers need to answer. In the era of Mass Media, the answer was relatively easy and the major limitation was the budget (e.g.: buy air-time on a major TV channel during prime-time). In the digital space, it is quite different. The variety of platforms means that the challenge is not anymore the budget, but rather the reach. Marketers have to define who they want to reach and what is the best platform. The era of Broadcasting is over, welcome to the era of “Narrowcasting” [MAYMA07, .39]. A successful Social Media campaign will use several channels, for instance: specialized websites, Social Networks, Blogs … and will, in general focus on a very specific group. According to Coca-Cola the “next big thing could be decidedly more niche” [ZMUDA10]. The distribution channels are rapidly evolving, and it is important to stay up-to-date and to feel which platform is the right platform to use for the message that the company wants to communicate. Email is not anymore the tool of choice for sharing content, in 2009 Facebook became the main tool for sharing information [OSTRO09].

The metrics / K.P.Is of Social Media

Measuring the Return-On-Investment (R.O.I) of any marketing activities is a prerequisite to a successful advertising strategy; furthermore, what cannot be measured cannot be improved. Just like any other marketing activities (e.g.: branding…), Social Media’s R.O.I need to be demonstrated, but a new set of Key Performances Indicators (K.P.I) need to be adopted. Companies will often measure the numbers of “followers” on Twitters or “Fans” on Facebook, but this metric is only the tip of the iceberg and is not always the most relevant. According to Lustig [LUSTIG09], companies should evaluate: the Reach, the Engagement, the Sentiment and the Business outcome. For each KPIs, specific tools are available (see Table 1).

Table 1: Social Media KPIs and monitoring tools, adapted from Lustig et al, [LUSTIG09]

Reach	Engagement	Sentiment	Business outcomes
- # of users reached - # of visits and unique visitors - # of page views - Content viewed	- Time spent, number of visits - Twitter follows or Facebook fan - Download, uploads, viral forwards	- Positive / negative comments - Survey, polls - Fan, friends	- Brand (awareness, affinity, perception) - Sales (actual, inquires, leads)
Example of commercial tools available
Crowd factory, Radian6, Cymfony, Nielsen Buzz Metrics	Biz360, SAS, Trackur, Cymfony, Cheskin		BBE, Insightexpress, Dynamic Logiv

Some references:

[MAYMA08] Maymann, J.: The Social Metropolis. Go Viral III. In: http://www.goviral.com/goviral_iii.pdf, file created on 2010-09-26.

[MAY10] May, P.: Interview with Peter May, Platform Manager at Vodafone. 2010-10-03.

[HENNI04] Hennig-Thurau, T.: Electronic word-of-mouth via consumer-opinion platforms: what motivates consumers to articulate themselves on the internet? Journal of interactive marketing volume 18 / number 1 / winter 2004.

[WHYTE54] Whyte Jr., William H.: “The Web of Word of Mouth,” Fortune, 1954-11, 50, p. 140-143.

[WATTS07] Watts, D.J.: Influentials, Networks, and Public Opinion Formation. Journal of Consumer Research. Vol. 34. 2007-12.

[KELLE03] Berry, J., Keller, E.: The Influentials: One American in Ten Tells the Other Nine How to Vote, Where to Eat, and What to Buy; Ed Free Press. 2003.

[BURSO08] Burson-Marsteller: The Power of Online Influencers: Your Company’s Newest Stakeholder Group. In: http://www.burson-marsteller.com/Practices_And_Specialties/AssetFile/E-Fluentials%20Brochure.pdf. File created on 2010-11-07

[PRIES10] Pries, P.: Interview with Peter Pries, Interim Senior Global Director Corporate Marketing at QIAGEN and owner of MarketingPlus X. 2010-10-25.

[CHENG09] Cheng, A., Evans, M.: Inside Twitter An In-Depth Look Inside the Twitter World. Sysomos Inc. In: http://www.sysomos.com/insidetwitter/. 2009-06.

[HEIL09] Heil, B., Piskorski, M.: New Twitter Research: Men Follow Men and Nobody Tweets. Harvard Business Review. In: http://blogs.hbr.org/cs/2009/06/new_twitter_research_men_follo.html. 2009-06-01.

[ZMUDA10] Zmuda, N.: Coca-Cola Looks for Another Billion-Dollar Brand, But Marketer Thinks Next Big Thing Could Be Niche Product. Advertising Age. In: http://adage.com/article?article_id=146778. 2010-10-28.

[OSTRO09] Ostrow, A.: Sharing on Facebook Now More Popular than Sharing by Email. In: http://mashable.com/2009/07/20/facebook-sharing-data/. 2009.

[LUSTIG09] Lustig, J., Rozic, S., Smith, M.: Measuring Social Media R.O.I. CrowdFactory.

Tibo's blog ... The Social Life of Health Care ...: Educate your doctor!

Tibo's blog ... The Social Life of Health Care ...: Educate your doctor!: "Have you ever had the feeling that your doctor (GP or specialist) doesn't really know what he is doing? That he is prescribing you the broad..."

Educate your doctor!

Have you ever had the feeling that your doctor (GP or specialist) doesn't really know what he is doing? That he is prescribing you the broad range antibiotics just to avoid a costly diagnostics ... but is this at your detriment? Have you ever felt that, sometimes, you know more than your doctor on some topics ... well ... just because you read a lot on the internet? I don't mean that everything on the internet is correct, but if you cross-check your references, and if you don't rely on a single source or only on what you heard on a forum from patients who have the same symptoms as you do, then you might be able to get a pretty accurate picture of what's going wrong with you. Again, I'm not saying that patients know better than their doctors ... but sometimes, patients spend hours on the net, trying to gather information on their conditions, they compare their symptoms with other patients, they read scientific literature, they go on Pharma companies's website ... and at the end of the day they have an idea of what might go wrong.

The access to medical information, just as any other information (news, politics, economy ...) has never been so easy, thanks to the Web. Social Networks and forums, have allowed people to exchange their opinions and to ask questions to their peers but also to experts. No wonder that people feel empowered and think that they can ask more educated questions to their doctors. Do doctors like that? Well, I'm not sure ... maybe the old school doctors won't like it because they come from a time where what they said was the only truth ... but I hope that the younger generation doesn't mind. After all, the "wisdom of crowd" produced things such as Wikipedia, which are pretty accurate!

Empowered patients can challenge the doctor, and I think that's better like that, because if you don't believe that what's the doctor asks you to swallow is good for you, then you won't take it ... or you'll go ask another doctor, and it will cost more to the community. But if you have a "lively" discussion with your doctor and he convinces you that this pill is good for you, then you'll take the treatment.

I think that the time has come where we need to "educate" our doctors, to let them know that we have information and that we are able to understand diagnostics.

Now a few questions for you:

• Do you feel that you have the right tools to discuss with your doctor?
• Where do you go to find information?
• What else would you like to have?

I'm looking forward to your feedback!

Cheers,

Tibo

How IVD companies can handle FDA regulation when they engage into Social Media?

DISCLOSURE INFORMATION:

My name is Thibault Géoui, I am a product manager at QIAGEN, a biotech company which is selling IVD products, nevertheless, the products that I am covering are not IVD products (R.U.O). This document has been written by me and for my own research, without the oversight of the company, its primary intention is to answer research questions that will be included in an MBA master thesis.

I want to find general answers that will serve the community: not only companies engaged in IVD, but also patients’ communities and physicians. What are the rules for engaging with companies online? What kind of information a company can and cannot provide on Social Media platform (e.g. blogs and forums)? How to deal with miss-leading information or off-label promotion which doesn’t originate for the company? ….

How to deal with Social Media in a regulated industry?

I am not a regulatory person, however I understand that one of the biggest concerns of my colleagues in engaging into Social Media activities, is the apparent the lack of regulatory framework. At the end of 2009, the FDA organized a hearing with companies engaged into Social Media, to work out rules and regulation for the industry, however the guidelines are not yet published, and although they might be soon, I am afraid that the lack of regulatory training of many marketers (and I first) might render those rules difficult to enforce, or limit the Social Media activities of many companies.

I already did quite a lot of research on that, but I have to say that I am a bit overwhelmed, and I don't really know what to do or what to think

First of all, I'm trying to get a big picture of how FDA regulates labeling and advertising in general, and also what is covered by the FDA, and what is covered by other regulatory agencies. On some websites, I read that the FDA covers only labeling (in its broadest sense) and that advertising is covered by the FTC, while on other websites, I read that FDA covers everything.

My latest reading says that according to the FD&C Act, FDA covers labeling and advertising and that the rules to follow are the following:

• Be truthful; that is, not false or misleading in any respect.
• Contain a fair balance of the risks and benefits of the device, with clear context, layout, and format of the information presented.
• Have adequate substantiation, based on well-controlled studies or supporting evidence.

In case of Direct-To-Consumer activities (and I guess that Social Media fall into that?), the rules are the following:

Include a brief statement requirement (section 502(r):

• Discloses the most serious and the most common risks associated with the device in either the audio or audio and visual parts of the presentation
• Makes adequate provision for dissemination (mailing, phone service, accompanying print advertisement, brochures in public places such as pharmacy … ) of the approved or permitted package labeling[1] in connection with the broadcast presentation

Off-label promotion

Not permitted except to medical professional, and not being proactive

Prelaunch promotions

Not possible because the claims are not yet approved by the FDA BUT the status of product development can be communicated with PR, and scientific data can be presented for educational purpose

Pharmacoeconomic claims

Can be done only with certain target groups such as health economics professionals, but not patient or MDs.

Relevant warnings, precautions, side effects, and contraindications (21 U.S.C. 352 (r)(2))

Is this relevant to IVD???

Do I forget something?

I guess that the challenges for Social Media are the following:

No control on the population that listens (except if the websites requires identification and is limited, let's say to healthcare professionals)

• No control on what is being said (except if any message is first moderated ... which doesn't work well for social media)
• No control on how the information is shared (from one network to the other)
• Not possible to continuously monitor activities (.e.g.: when a marketing campaign is finished the monitoring activity will stop, but everything stays on the Web and might be still commented by users)
• Temporality might be an issue, e.g.: Twitter, blogs or forums are instantaneous, while standard marketing communication is always controlled by the regulatory affairs department, therefore a specific training might be required for marketing professionals who will engage into conversation on such platform
• ...

I guess that there are other limitations, which make Social Media a challenge to use, on the flip side, there are also benefits for the patients and health care professional if a company starts to use Social Media:

• First hand information on what the product does and doesn't do
• Reference to the right information (it is possible to point people to white paper, scientific publication or company website where they will find the right information)
• Helping not only patients but also communities of patients by providing guidance in term of the above mentioned information
• Chance to correct some of the miss-leading claims that are done by other patients or support groups on blogs and forums
• Support in pointing out to an adequate solution for a patient seeking information (but here again there is thin line between advertising and giving advice ... how to deal with that?)

Ultimately, should the Social Media activities been done by a marketing professional with a regulatory training or should we sponsor physicians or patients with a specific training to do it on our behalf (with the appropriate disclosure of relationship with a company, e.g.: financial ...)?

Any comments or correction are more than welcomed.

Feel free to contact me at the following address : thibaultgeoui@gmail.com

Dr. Thibault Géoui

[1] Labeling might be too technical for most patient, therefore it is suggested that a abbreviated version of the labeling be produced with the following information: “indications, contraindications, warnings, precautions, and adverse effects” , nevertheless patient need to be informed that this is an abbreviated version of the label

References used in this document come from:

• Daniel Schultz, FDA Oversight of Direct-to-Consumer Advertising of Medical Devices, FDA, online publication: http://www.fda.gov/NewsEvents/Testimony/ucm096272.htm
• Philipp Novales-Li, Policies guiding the advertising and promotion of IVD products, IVD Technology, April 2009, online publication: http://www.ivdtechnology.com/article/policies-guiding-advertising-and-promotion-ivd-products
• Diagnostic Kits/USA Regulation Review, online publication: http://cyber.law.harvard.edu/commonsbasedresearch/Diagnostic_Kits/USA_Regulation_Review
• Draft Guidance for Industry and FDA, Consumer-Directed Broadcast, Advertising of Restricted Devices, FDA
• Guidance for industry, “Help-Seeking” and Other Disease Awareness Communications by or on Behalf of Drug and Device Firms, FDA, online publication: http://www.fda.gov/downloads/Drugs/GuidanceComplianceRegulatoryInformation/Guidances/ucm070068.pdf

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