For the first few weeks everything is humming along like a well-oiled machine.  You engage regularly via Twitter, have quickly cultivated a base of patients on Facebook and have managed to churn out several blog posts.  Everything was going swimmingly as enthusiasm ran high.  But slowly, something changed.  The pace of followers decreased, posts don’t seem to come to life as readily and your Twitter engagement gets pushed to the backburner as that budget meeting looms.

What happened?

Your pharma social media strategy met the fate of many that have gone before it—a lack of content creation.  What started out well-intentioned and maybe even well-planned met its match.  Content creation: where pharma social media goes to die.

Social media programs often start out with the best intentions.  But what many people fail to realize is that social media is difficult.  It takes dedication.  It takes time and it takes internal resources.  It’s not as simple as simple as throwing up a couple of random 140 character thoughts every once in a while.

Content creation is a long slog.  Before you make the commitment to social media, survey the content you already have in house.  If you have a vault of videos that have gone untouched, that might be a good place to start.  Do you have an internal newsletter that might transition well to an external blog?  Think about using that as part of your content creation strategy.  And as rudimentary as it sounds, consider creating an editorial calendar to outline predefined topics for blog posts and assign authors.  This will create some accountability at the outset.  Eventually, you won’t need the calendar as a set of people will become engaged and motivated to post on their own.  But that won’t happen overnight and creating some urgency through a set timeline of posts will keep momentum moving forward.

Content creation is in many respects the linchpin of social media engagement.  It is a wonder then that it often spells the demise of many efforts.

That was a satisfying piece of information in the sense that I’ve long trumpeted the need for social media strategies focused on the Return on Health of the patient.  It’s always nice to affirm that you are not crazy.  It was frustrating because what I heard from the table was it was a need mostly going unmet. What became apparent to me during our dinner was that this is not a problem that can be solved by pharmaceutical companies in isolation.  Just like pharmaceutical social media engagement should not take place in a vacuum, creating a healthcare system where the patient is empowered to play a larger role in the decision-making process requires systems thinking.

Pharmaceutical companies can lead the charge in part because of their unique access to information but also because of their substantial sphere of influence.  Pharmaceutical companies have access to the best information available on treatment options, dealing with side effects and current research.  Like it or not, they also have pull on capital hill, with insurance providers, in the doctor’s office and with the patient.  Pharmaceutical companies must serve as the catalyst to empowering the patient.

But the process can’t stop there.  As agency people, we tend to focus our energies on swaying the folks that write the checks.  In order to truly empower the patient, we need to broaden our field of vision.  How can we expect the empowered patient to achieve a good outcome when doctors are incentivized to see more patients and not spend more time with patients?  What good is an empowered patient if she can’t find information on the latest clinical trials on her rare disease because search algorithms do not lend themselves to uncovering that information?  What’s the use of an empowered patient if doctors are not trained to take input?

I admit I am raising a problem far too complex for me to solve—something that requires brains far smarter than mine.  But I am smart enough to realize that pharmaceutical companies engaging in social media alone will not empower the patient—we need the collaboration of lawmakers, insurance providers, hospitals, doctors and patients.

Even with this complexity, it all centers on the patient.

Much of the pharmaceutical social media conversation has focused on the need for change from the market tactics of yesteryear.  The argument goes something like this: “agree or disagree, the pharmaceutical industry is one of the most distrusted and its public perception is overwhelmingly negative.  Why?  Fair or unfair, many point the finger at the barrage of DTC ads as a sore point.”  Using that logic, the strategy tends to be something to the effect of “change everything.”

It’s not all wrong.  I for one have been a proponent of pharmaceutical social media as a step in the evolution of the industry’s marketing.  No doubt, the pharmaceutical marketing has been evolving over the years to fit better with a business less focused on blockbuster drugs and mass markets and more concerned with areas of high unmet needs and building relationships.  So by all means, move forward with radical changes to the way you form marketing strategy, but don’t disregard your past entirely—you might miss a crucial lesson.

Today, Wendy Blackburn from InTouch Solutions reposted an article that she authored (originally ran in Med Ad News) focused on how pharmaceutical companies can take a more customer-centric approach to marketing (similar to my Return on Health concept).  Within that post, Wendy briefly mentions an interesting point: “patient support call centers have been around a long time. What’s so difficult about duplicating that experience online? Why not empower a corporate spokesperson to speak online on behalf of your company and your brand?”

This is an example I’ve used on occasion before: if pharmaceutical companies can trust call center employees to handle patient support functions, why can’t they replicate that process for an online team?  There are really only two (honest) answers to this question.  The first is that online platforms expose the companies to added risk and exposure to the FDA.  The issues are the same as what might be handled in a call center but when dealt with in a public manner, the feeling is that companies are being watched.  Call centers don’t face that challenge.  Second is a problem of scale.  Call centers provide a finite and defined environment.  The company can control (to some extent) the calls it takes in a day, the hours it receives calls and the process for responding.  The real-time nature of the Web makes this level of control impossible.  That’s really about it: too much scrutiny and not enough resources.

Yet, people tend to ignore examples of the past even if they have worked.  Call centers have worked in the pharmaceutical industry for the most part.  So here is what it comes down to: do you trust your call center employees more than your communications manager?

Of course, this level of content creation takes a commitment to social media that many companies might not yet be willing to make.  Who can blame them?  In addition to appointing some individual to monitor and respond to social media conversations, you now need to create engaging content within the boundaries of FDA regulations.  A significant time sink indeed, but one well worth the investment if done properly.

But in thinking about the topic, it occurred to me that this outlook on the involvement of pharma companies in social media is far too narrow.  Sure, it is easy for a pharmaceutical company to serve as an information broker.  But what about their role as a creator or energizer of patient support groups?  Is it even appropriate for healthcare companies to step into this area?

I realize this is not an entirely new concept.  Some companies have already done a solid job of connecting patients around  disease states.  But by and large, this is an area that pharmaceutical companies tend to steer clear of for a variety of reasons.  For starters, there is often an active and engaging online support group established.  Why disrupt the status quo?  In addition, pharmaceutical marketers have long had trouble defining their customer.  Ultimately, the patient is overlooked in favor of efforts directed at doctors, insurance providers, etc…

That needs to change.  For pharmaceutical companies to have any measure of success in social media it needs to focus on Return on Health and the patient.  This patient-centric view leads me to believe that a large part of pharmaceutical social media efforts in the past will be about creating and energizing patient support groups online.

Right now, healthcare companies are best suited to dispense information. In the future, they would have a better grasp on their patients and be best suited to provide a platform for support.

Forget about extending your brand, getting more prescriptions and enhancing your reputation (all of which will come by the way).  This is about providing a much-needed outlet to an often underserviced community.

There are two key takeaways from this report.  The first is that individuals living with a chronic disease are less likely to have access to the Internet.  According to the report:  “81% of adults reporting no chronic diseases go online and 62% of adults living with one or more chronic disease go online.”  The report goes on to indicate that this is an indication not of desire to go online, but of access to the technology required to go online.

The second key takeaway is that if all variable factors are weighted equally, individuals dealing with a chronic disease are more likely to go online in search of health information and far more likely to consumer user-generated content.

As pharmaceutical marketers, the obvious question is “how does this data impact my efforts?”  As I stated earlier this week, every social media engagement strategy should start and end with the patient.  The focus has to be creating better patient outcomes.  In order to move forward in that process, an understanding of the patient is paramount.  This study from Pew helps healthcare companies better understand the behavior of the patient.

The data supports the idea that social media is not a silver bullet.  The reality is a significant chunk of the patient population is not online.  Clearly, social media is not the right avenue to reach those patients.  Traditional forms of marketing (including PR) still hold relevance in reaching this segment of the population.  The Pew report states that the lack of access to the internet creates an information gap for patients that are not online.  Pharmaceutical companies should focus a piece of their efforts on bridging that gap.  As always, social media is but one part of a integrated marketing strategy.

The plus side of this report for social media advocates is that it confirms what we have always known—those patients that do have access to online content consume it voraciously.  Anecdotally I know this to be true.  My Mom battled Melanoma for 3.5 years and was constantly online looking for new research, treatment options and support groups.  In some small way, it helped her feel connected to a community and less isolated in her struggle.  That’s no small feat.  Social media remains a powerful platform to engage with patients, hear their feedback and work toward the lofty goal of achieving better outcomes.

Where does the patient fall in your social media thinking?

Few people would disagree that strategy is an integral part of any social media engagement.  Despite what many people might assume, social media is not something marketers should engage in without a clear purpose or goal in mind.  But how to arrive at the strategy is less clear.

Traditional marketing metrics become less quantifiable in social media.  You can’t measure the success of a campaign because campaign thinking fails in social media.  You can’t focus solely on bottom-line impact or your efforts will come across as blatant attempts to promote.  This leaves many marketers in a pickle—without a point to work backwards from; forming a coherent strategy is a difficult task.

But it doesn’t have to be.  Too many marketers walk into social media engagement planning focused on how to get the most eyeballs.  If that were the only measure that guided social media strategy it would quickly become extinct.  There are much more efficient ways to simply hitting eyeballs than using social media.

The better approach is to focus on Return on Health (ROH) and consider the behavior of your patient.  Thinking first about the behavior of your patient will guide you to the right platforms.  For example, if you are dealing with an ailment that generally impacts children, what is the first thing a parent will likely do upon learning their child is inflicted with this ailment?  Most parents search for answers and will head to Google to find them.  The trick is to ask yourself, what type of information are they looking for in this search?  If they are searching for insight on treatment options, severity and past experiences, you can gear your social media efforts to reflect that.  You should also survey what online sources of information already exist.  Have you considered Google Health as a source of information for patients?  Better still, have you tracked down the sources of information that feed into Google Health and ensured its accuracy?  If you are not proactively addressing these questions you are leaving your online presence to chance.  What about a platform such as Yahoo! Answers?  Have you scanned the discussion taking place there to get a sense for the sentiment about either your brand or the common concerns of dealing with a particular ailment?

The bottom is this: social media strategy too often focuses on superficial measures as its guide.  Metrics like unique visitors per month, pages viewed per visitor and bounce rate should not inform our course of action.  These are only surface observations and are weak when used as guiding lights.  Social media strategy should start with the patient.

Today, the PhRMA turned up the pressure on the FDA by putting a bit of marketing muscle behind its FDA comments. Knowing full well that few people would take the time to read the entire 16-page document that makes up the PhRMA’s comments to the FDA, the organization issued a statement containing only the highlights.

As expected, the statement built the case on why social media is an important tool for pharmaceutical companies.  The PhRMA highlighted that more patients than ever before are going online to access health information and healthcare companies have a responsibility to ensure that information is timely and accurate.

From there, the PhRMA took an interesting approach to forcing the FDA’s hand.  They went with what I will call the “if you can do it why can’t we” approach.

Behold: “What’s more, the Agency should avoid chilling manufacturers’ responsible communication about their medical products and should permit them to take full advantage of the same technologies that the FDA and the White House use – including blogs, video, search and such social networking sites as Twitter™ – to communicate important health information directly to patients and their doctors.”

That’s fairly strong language for an organization that tends to tilt toward the conservative when it comes to messaging.  There are a number of sections in the PhRMA’s public comments to the FDA that read very similar.  Bravo!  They are dead on when it comes to this topic.  The FDA has demonstrated through its actions that it sees the value provided by social media in communicating information to doctors, patients and other relevant healthcare audiences.  The PhRMA is just conveniently pointing that out.

Pharmaceutical companies engaging in social media should do so only if they have more value to add to the community than they extract.  They should not be there solely to push product and should focus on the Return on Health of the patient.  This means a commitment to creating better health outcomes for patients by providing more access to information.  The PhRMA is not-so-subtly driving this message home and attempting to place added pressure on the FDA. I for one hope it works!

(Side note: every one of the above links is worth clicking on for a unique perspective on this topic.)

The debate on ROI for pharma social media has centered on the question of whether or not it is even the right form of measurement.  It’s a topic I have been railing against for months so I will be brief here. One major problem with ROI as it pertains to social media is that it is a lagging indicator. By its nature, it is designed to evaluate the success of a program, in financial terms, at a given point in time (usually the conclusion). There’s a fundamental flaw when you apply that approach to social media.  Social media is not a campaign—it’s an engagement.  ROI does a great job of measuring campaigns, but is a little less concrete when it comes to sustained efforts. When I measure a program, I want to know in process where there are shortcomings so I can adjust accordingly.  ROI fails to provide that ability.  It is useful as a tool to prove value after the fact and move forward. It also should not be dismissed off hand and certainly has a place in the measurement toolkit. Perhaps a better way to approach measurement is something I’ve termed Return on Health (ROH).  When developing an integrated marketing strategy, the first steps are less about concrete numbers and more about establishing a basic decision-making framework. The patient should be at the center of any pharmaceutical social media effort. With the patient at the center, you have established a framework that provides a clear and distinct guide as you seek to engage more actively in relevant communities.  Essentially, it boils down to a simple principle, have an outcome in mind and map your efforts based on how they will help achieve that outcome.

Let me be clear: social media should not escape measurement.  But to rely solely on ROI as the measure of success or failure is insufficient.  ROI is a point in time measurement.  More sophisticated measurements are needed to move the discussion forward when it comes to social media for pharmaceutical companies.

At least that’s the theory.  But what happens when that theory is flipped on its head?  If patients no longer need pharma companies for access to quality information their role in social media becomes a bit murky.  This is exactly what’s starting to happen with the advent of Google Health and Bing Health.  As Jon Richman details on Dose of Digital, Google Health and Bing Health not only point patients to credible information, they provide access to it without ever having to leave the search engine.

Check it out:

A search for Melanoma returns the screen on the left, with links to Google Health, Mayo Clinic, Medline Plus and WebMD.  If you click on the Google Health Link, there is hordes of information gathered from highly credible sources.  The result is much the same with Bing, except Bing takes it one step further by providing treatment options and access to patient ratings of those treatment facilities.  With so much information available after one simple search, there is little reason for a patient to click further.  This is a very real threat to pharmaceutical companies hoping to provide patients with access to pertinent information.  Jon outlines steps pharmaceutical companies can take to help themselves from an SEO standpoint.  His suggestions are spot on and I suggest you click through and take a read.  For my lazy readers, I’ll summarize here: find out where the information is coming from and ensure its accuracy, improve the performance and content of your own Website and don’t neglect paid search to boost the prominence of your own performance with relevant search terms.  Since Jon has that part covered, I’ll focus on how this impacts pharma social media and what pharma companies can do to respond.

First off, remember the central question of pharma social media of what’s the Return on Health (ROH) for the patient?  In other words, keep your patient front and center when considering how to engage in social media within a framework where Google and Microsoft are attempting to limit the reason for your customer to ever leave their respective sites.  As a pharmaceutical company focused on ROH, you know your patient better than that.  You know very few patients dealing with a serious illness are content to visit just one site—no matter how credible it may be.  So don’t panic.  Continue with your listening programs and evaluating where your patients are congregating.  Those are still worthwhile destinations for transparent interaction and patient participation will not diminish as a result of Google Health.

There is also an aspect of “influencing the influencer” here.  By understanding how Google and Bing Health are populated, as a pharmaceutical company you can engage directly with those sources both in a traditional PR capacity and at the social media level.  In doing so, pharmaceutical companies can play a role in shaping the content the patient will see when searching on health conditions.

Finally, pharmaceutical and biotech companies need to commit to creating better content.  Google will inevitably win at its own game.  But that doesn’t mean that pharma companies should simply throw in the towel and call it a day.  As we stated earlier, healthcare companies are the gate keepers to a wealth of knowledge.  Use this as an opportunity to break the gates wide open.  Social media provides the platform for the democratization of knowledge.  Quite a noble goal huh?

So there you have it: Return on Health, influence the influencer and create better content.  If you couple this social media strategy with the SEO pointers provided by Jon, pharmaceutical companies can play nice in the Google sandbox.

Social media focused on regulatory concerns only does not line up

Those of you that have read this blog more than once know that I have been beating the Return on Health (ROH) mantra lately when it comes to pharmaceutical social media.  The thought is that far too many social media programs start by considering how they will extract value and not how they can add value.

That’s a misaligned process.  Instead, marketers need to start by focusing on the patient with an eye toward how their interactions will enable access to more information and better health outcomes.  That’s the value you bring to the able as a pharma marketer.  That doesn’t mean you ignore your ultimate goal of building a brand that drives more revenue.  But instead of starting off with that at the forefront, you rely on a marketing principle that fosters long-term and authentic engagement.  It’s a significant shift in thinking but one that is critical if social media ever hopes to gain widespread adoption by pharmaceutical companies.

That shift in thinking is needed across the board and includes things like our fixation with adverse events and off-label usage.  I am as guilty as the next guy when it comes to spending an inordinate amount of time thinking about how to handle these very important issues in pharmaceutical marketing.  And we should continue to give careful consideration to where they fit into a social engagement strategy.  Dismissing AEs and off-label usage discussion as non issues demonstrates a clear lack of perspective.  These topics remain at the forefront of every pharmaceutical legal, compliance and regulatory department, and thus should remain a part of our conversation.

But we shouldn’t limit our discussion to solely focus on how to navigate the issues of adverse events and off-label usage in social media.  Why?  Because focusing the conversation in this area relegates the patient to the sidelines.  How many patients know what an adverse event is and even realize they are discussing off-label uses for a particular drug?  I would venture to guess is it a very small minority.  These types of issues, though important, are really geared at how a company can limit its liability with regulatory bodies.  It’s a necessary step and a conversation that needs to occur, but perhaps not at “stage one.”

The better approach would be to work from the patient out.  As pharmaceutical marketers, first ask yourself if there is a concrete reason for you to be engaged in social media.  If the answer is no—stop there.  Go no further.  Starting off the discussion focused on adverse events and off-label usage reverse engineers the process.  It starts with a company-centric point of view and eventually finds its way to the patient.

Successful engagements will start with the patient in mind and incorporate regulatory planning only if the first criterion is met.