Thought Leader Round Table Discussion

The following panel discussion (with members of the Digital Health Coalition) originally took place on October 13, 2011 at the Marketing to the Digital Consumer conference in Fairfield, NJ (hosted by DTC Perspectives). Thank you to the team at DTC Perspectives for hosting the event and allowing the Digital Health Coalition to reproduce the transcribed version of the panel discussion as a white paper. The Digital Health Coalition, a nonprofit organization with 501(c)(3) status, was created to serve as the collective public voice and national public forum for the discussion of the current and future issues relevant to digital and electronic marketing of healthcare products and services.

DISCLAIMER The comments and opinions expressed in this panel discussion are the comments and opinions of the individuals and do not reflect or imply an official endorsement from any company, brand, or employer.

Copyright 2011 Digital Health Coalition. All Rights Reserved.

SPEAKER BIOS

Mark Bard Digital Health Coalition Mark Bard is the co-founder of the Digital Health Coalition, a 501(c)(3) nonprofit organization dedicated to fostering innovation in digital health. Mark is a new media, marketing, and technology entrepreneur. In addition to personal ventures, he also invests in early stage technology and digital health startups taking an active advisory role with founders. With deep expertise in the digital health space, Marks focus and passion includes mobile, social, search, and customer service in a digital world. With over 15 years of industry experience, Mark is an internationally recognized expert on topics including the Internet and the healthcare system, new media, health information technology trends, mobile, social, and pharmaceutical sales and marketing.

Joan Mikardos Sanofi Joan Mikardos has over 20 years media experience across a variety of industries and she joined Sanofi US in 2007. She is Senior Director, Digital Center of Excellence. In her tenure at Sanofi US, she developed a media capability for the company that drove more strategic use of media investments across all channels. She previously had oversight of the companys media investments. In her current role, Joan focuses on identifying and developing application of new digital communications tools, including social media, across the organization. Prior to joining Sanofi US, Joan spent many years on the agency side. She was an SVP, Managing Director at Universal McCann/J3 where she led media planning for J&Js McNeil Consumer Healthcare division. She was a driving force in testing new technologies for those brands and altering the companys media mix.

Jeremy Shane HealthCentral Jeremy Shane is President and Chief Operating Officer of HealthCentral, overseeing day-to-day operations at the company and responsible for audience growth, user engagement and revenue. Shane joined HealthCentral in January 2006. Prior to joining The HealthCentral Network, he was Co-Founder and CEO of Versify Solutions, LLC, an enterprise software developer focusing on the wholesale power industry. Previously, Shane was a founding member of Power Team, the wholesale power marketing unit of Exelon Corporation (NYSE:EXC). During 1991-1992, Shane served in the U.S. Department of Justice focusing on Federal health care policy. He graduated magna cum laude from the University of Pennsylvania with a B.A. in International Relations.

Jay Goldman Klick Jay has been providing a human side to technology for over ten years, as a technologist, user experience specialist, and visual designer. His career has been focused on the interaction between people and technology, and his insights have helped to greatly improve products on mobile, web, and desktop platforms, including IBM DB2 and Mozilla Firefox. He co-founded and led Radiant Core, was the Head of Marketing at Rypple, and is now VP Strategy at Klick. Jay has taught courses for The Learning Annex, hosted Mr. Mobile and Status Update podcasts for Butterscotch.com, wrote The Facebook Cookbook for OReilly Media, and has been proudly published in the Harvard Business Review.

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Gautam Gulati Digitas Health Dr. Gautam Gulati works and plays at the intersection of health, education, innovation, design, and entrepreneurship. Dr. Gulati served as SVP for Digitas Health, leading the Science & Medicine Division of the NYC office. Additionally, he served as a Life Sciences Strategy Consultant with The Frankel Group and Global Medical Director for IntraMed/Sudler & Hennessey. As a physician consultant, he provided strategic recommendations for the FDA as well as for various healthcare related Internet companies, including MDLinx. Additionally, Dr. Gulati is an adjunct professor at Johns Hopkins University Carey Business School where he teaches a course titled "Medical Innovation and Entrepreneurship". As an outpost to his academic musings, Dr. Gulati acts as an industry advisor to a number of change-makers and innovators in the health field through his idea experiment lab called GULATI. NOTE: Since the panel on October 13, 2011, Dr. Gulati has accepted a position as Chief Medical Officer at Physicians Interactive Holdings.

Peter Pitts Center for Medicine in the Public Interest Peter Pitts is President and co-founder of the Center for Medicine in the Public Interest. Prior to founding CMPI, Pitts was a Senior Fellow for healthcare studies at the Pacific Research Institute. From 2002-2004 Peter was FDAs Associate Commissioner for External Relations, serving as senior communications and policy adviser to the Commissioner. He supervised FDA's Office of Public Affairs, Office of the Ombudsman, Office of Special Health Issues, Office of Executive Secretariat, and Advisory Committee Oversight and Management. He served on the agencys obesity working group and counterfeit drug taskforce.

Copyright 2011 Digital Health Coalition. All Rights Reserved.

MARK BARD (DIGITAL HEALTH COALITION)

You probably recognize a lot of the folks up here. This is a very diverse group. Theyre all actively involved with the Digital Health Coalition. Ill give a little bit of background of what that is and what were trying to do since launching in June. Jay Goldman with Klick -- one of the first companies that really stepped up and said hey, this is a great idea. We want to get involved. Jay (aka Mr. Mobile in some corners) has phenomenal insight into mobile and social. Peter Pitts, certainly one of the when it comes to policy and a lot of topics that I dont personally understand he knows a lot more than Ill probably ever know in my lifetime on how a lot of things work. Peter is working with a number of leading companies to figure out the landscape. Dr. Gautam Gulati with Digitas, an expert on the intersection between physicians and patients. Hes got that unique insight into the concept of the physician entrepreneur that is so elusive. I think today it is how we find those physicians like Daniel Kraft and all these other guys who see that intersection of medicine with business ideas behind it. Jeremy Shane with HealthCentral not only a really smart guy but from a content perspective HealthCentral is really facilitating that entire user generated content movement. Also involved in a project that I wont go into detail in today but the e-Patient Bill of Rights. If you want to learn more about that you can visit www.epatientbillofrights.org. You can pledge your support and learn more about that project. Joan Mikardos with Sanofi. Everything Ive seen and heard from Joan over the years is focused on trying to figure out how technology supports the care and decision making process. Ultimately, the patient has to be at the center of the technology. Thats clearly not the case when the vast majority of companies still force anyone in the digital realm to call an 800 number. Were not talking the same language. Were going to get there as an industry and its going to take a little bit of time and I think Joan certainly has some insight and foresight to offer -- where this market is heading. If you were here yesterday there was a lot of great conversation about how we cant take it anymore. We need to figure it out. I think Bill Drummy always does an excellent job of saying and Im going to paraphrase -- Were all idiots. We need to stand up and do something!! You know hes got different ways of saying that but I think it really rings true that we keep talking about the same things. That frustration is part of the motivation driving the Digital Health Coalition.

Two hundred million people use the Internet for health today. One hundred million use it for social health. Theyre increasingly using it for mobile health information. We saw numbers from Google. What is it? Twenty six, twenty seven percent of people do drugs searches through mobile. Were there. Were not debating numbers any more. Were not debating Internet adoption. Were debating how many devices are connected per person.
Right, were beyond that conversation. Even the C-suite understands how their daughter uses Facebook and theyre starting to think they may want to friend their wife on Facebook as well. Were having these conversations today. I heard an interesting piece driving out in this lovely weather this morning on NPR and they were talking about the driving forces behind social and cultural movements. The Arab Spring and Occupy Wall Street -- you really get down to the fundamentals and youve got a situation where the masses, basically populations saying I dont believe what the government or regulatory bodies are telling me. It defies common sense. Thats sort of what were trying to facilitate -- to say -- how can we form a voice for the digital health industry? We started seeking out the innovative pharmaceutical companies, some of the innovators like Sanofi and Lilly and some of these other companies that are actually trying to do things out there today. The innovative agencies and the policy experts -- trying to get a lot of people as part of the conversation and discuss practical solutions. If youre interested in learning more you can go to digitalhealthcoalition.org. Our first priority is to discuss practical innovation specific to social and user generated content. What are some of the key things that we can agree on? Lets not get into the weeds too fast. Lets agree on things like adjacent content thats safe. Why are we not doing this? Lets figure out ways to participate in the conversation. It is bizarre.

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We live in this day and age when you have customer service with every other industry but yet we cant have conversations with an industry thats saving lives each and every day. I cant remember who said it yesterday -- you know, were not exactly the tobacco industry.
Thats obviously the far extreme. But you know this is an industry that is saving lives and being afraid to have honest conversations is just bizarre. Its not just me -- I think a lot of people in this room agree with the need for change. So what were going to do is kick it off and I do want to make sure we keep time for questions because I do want this to be interactive. I learn as much at these conferences and town hall meetings weve been doing at various events as you probably do sitting in the audience because I love to hear different opinions. Were going to kick it off with a two minute opening statement and then were going to go to some structured questions and then Ill open up to Q&A. Jeremy, Im going to put you on the spot first.

and talking about integration of devices and drugs and those kinds of things.

Theres greater acceptance now in the patient communities to be involved with pharma and thats an awesome additional point of view thats going to accelerate.
The second point Id say is that it compliments both of the technology of the devices that were discussing today. I think Gautam has some great points to make on this point. But theres the complements of the technologies that were using and also the technology of drug discovery which is to say drug discovery is becoming much more targeted. You need to meet people in many different kinds of environments and certain kinds of pharmaceuticals are going to work for people and certain kinds are not. And as a drug maker youre not going to want your pharmaceuticals to be used by people for whom it is not going to work. And so that pressure around outcomes, the ability today with the targeting around the technology, the capability for people to broadcast on their terms, you know what theyre doing or their kinds of activities, is an incredibly important trend. The final thing Ill say is just about the importance of social. I think theres a bifurcation that weve got to be careful about in terms of social as to what social means. There is obviously the social communities on Facebook and the platforms in which conversations can happen.

JEREMY SHANE (HEALTHCENTRAL)

Thank you, Mark and thank you for this panel. Its great to be with these folks and thank you for your time -- the folks who are here today. I think three quick points that Ill make. One is that I think there is a confluence here in terms of pressure that is coming in the conversation from both the patient side as well as from the marketing side. Historically the marketing conversation has been how we go out and meet patients and find patients and talk to them as pharmaceutical companies. Increasingly, I think patients themselves -- you talked about the ePatient Bill of Rights and the communities that we have on HealthCentral and some of our other properties and across other properties -- are talking to each other. We see that the patients are much more interested to go out and engage. And you have to understand that in a lot of these patient communities the notion of talking to pharma or talking to device makers has sort of been frowned upon. As Mark indicated, pharma is something that is not exactly a participatory kind of experience today. Ill wait for Joan to talk about what Sanofi has done with some of the diabetes patients and meeting them half way --

But increasingly social is about the way people want to experience it, not just in health but in everything else thats going on in Twitter and in StumbleUpon and Facebook. Its about serendipity and discovery of what other people like you are doing or seeing or finding enjoyment and value in.
And so your ability to control the degree to which social networks out there have influence or the social networks rebroadcast your messaging or amplify your messaging is limited. But you have to be in a lot of different locations to find and meet those people who can create bumps or events that really give social a kind of currency.

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Just kind of a slight, a quick sort of anecdote from HealthCentral: a couple of weeks ago we had a BMI calculator and the BMI calculator is kind of a standard function populating one of the social networks -- we got forty thousand pages out of that. I think it was gone a couple of days later. But what that indicates is both the ability to find key influencers in social and the inability to control the amplitude of when that message is going to get amplified in the way that you want.

We know so much about the products that we make that they feel information from our label is from a knowledgeable source.
Ill say another thing that came up at another conference. There was a patient panel and a woman was talking about how she was on a post-menopausal drug. She said she would never believe anything this pharma company said because in their label it says if you are pregnant yet this drug is for post-menopausal women. So she said how can I believe what they say when they have this in their label? So I informed her that the FDA requires that. Its not the company. the patients on the panel couldnt believe it. I feel there is a huge opportunity to become more transparent with what were held to or we should work more closely with the FDA to dispel some of those myths that are out there. Well see. Hopefully being part of the Coalition well be able to tackle some of these things.

MARK BARD
Great. Thank you. So, Joan. Sanofi is typically one of the companies that you can point to say they are not just engaging in snapshot listening or saying were doing something on Facebook with no comments -- but youre actually doing things. So whats your take on the market today?

JOAN MIKARDOS (SANOFI)

Thanks. Im thankful to say we are doing things and I dont use excuses -- We work together to figure out how we can do it in a way thats appropriate for a pharma company and in a way thats meaningful for patients and physicians. So Im thankful for that in our organization but we dont move fast enough. I think it still takes longer than it should to reach that consensus and that place where we need to go. So one of the things Im really trying to drive in our organization is this digital mindset which is not about the technology and thinking that digital is the technology but its how do we do our job and really act agile and quick like were a technology company. And so I think what holds us back is the bigness of the organization and the structures and the silos that were in. But Im optimistic that were modifying ourselves and adjusting. Hopefully we will become a little more agile than we currently are.

MARK BARD
Great. Jay, Im going to jump to the end over here, maybe building a little on the site www.epatientbillofrights.org. What are your key insights?

JAY GOLDMAN (KLICK)

We like to take the approach at Klick that were all patients at some level and that in the very near future, were actually already there in many areas, all patients become e-patients and for those of you who arent familiar with the e-patient movement, the e in e-patient isnt necessarily electronic -- although it often does in fact mean that but really to the origins of the movement it means people who are engaged, empowered, enabled and educated about their own health care. So rather than doctor as God and Im going to do whatever my doctor tells me, this is about patients saying I can take control of my own health care. I can become just as educated or more educated than my physician and I can take control of it and I feel empowered to do that. Increasingly that is done through electronic means.

One of the other comments I was going to say is to a point about patients wanting to hear from pharma. I believe that is so true and I think the work weve done today in the diabetes sphere is a testament of the fact that these patients are really thankful and they want to hear from pharma.

Copyright 2011 Digital Health Coalition. All Rights Reserved.

When we look at e-patients we recognize an opportunity for our clients -- who are largely on the pharma side -- to take advantage of that channel to deeply engage in that conversation. Now we obviously have regulatory limits that prevent that deep engagement right now. Thats a big part of the reason why were working with Mark and the folks at DHC to try and open up some of that regulatory.
Mobile plays into this in a big way because as Mark mentioned in his opening were increasingly accessing these channels through mobile. And we actually look at mobile as an accelerator of the social technologies. The two are very closely knit together which is actually why I have the very lucky position that I have at Klick of doing strategy for both mobile and social. Because it is rare that we tackle a project where one of those is mentioned and the other one isnt. And so as we increasingly have smarter phones in our pockets, those of you who upgraded to IOS5 today who even have smarter phones in your pocket or who tried to upgrade to IOS5 but werent quite able to. As we increasingly have smarter phones in our pockets with more mobile bandwidth and faster connections that distinction of the activities that we do on our mobile or at home start to go away a little bit. And we often get people whore using those mobile devices as a second screen. I remember some great stats out of WebMD about their usage curve during the day and it started to slowly shift outside above the day and they were a little confused about why that shift was happening until they realized that that shift was purely on iPads.

second screens while were doing other things and certainly those other things are research, theyre looking up information.
Its seeing an ad for a drug that pops up during your TV show and immediately accessing the web site for it while youre sitting on the coach. Thats a big shift that we need to be able to be able to figure out how to respond to. So Ill wrap up by saying, I think the rate of technology change is accelerating and the technology business does not respect industries that dont move as quickly as the change moves. If you look at an industry like the music industry until Apple helped them out with iTunes, it was going to be in a lot of ways the death of that industry. Their failure was their inability to move as quickly as the rate of change and that was causing their business models to become invalid and irrelevant. Were going to see a similar thing happen to the movie industry. I think Apple may have saved them in that regard too with iTunes. That was just being held back by the amount of bandwidth that was available. It would be a shame for the same thing to happen to the pharma industry because of our inability to move as quickly as the rate of change. Because I can tell you that the companies that are building the stuff, Facebook and Google and Twitter arent going to slow down because the pharma industry isnt keeping up with them. So its our obligation and a big part of the reason why were on this coalition to figure out how to move as quickly as the rate of change is happening.

MARK BARD
Great. Now Im going to drive Peter Pitts crazy and make him go last, sorry. Gautam, you have a very unique position. You know that integration between physicians and patients the communication and dialogue and everything that comes in between. Some key insights?

So physicians were going home at the end of the day sitting down on the coach and while they were watching TV they were taking out their iPad and doing a bunch of the research that they would have been doing during the day. And for us that shift is a really critical one because it means were starting to use these devices as

GAUTUM GULATI (DIGITAS HEALTH)

Sure. Thanks, Mark and thanks for having me here on this panel. Like you mentioned, I have two perspectives. One is going to be from the agency perspective and how we think through the patient physician communication and marketing piece and the other is more of a physician entrepreneurship angle. Im going to start off with

Copyright 2011 Digital Health Coalition. All Rights Reserved.

more of the agency perspective. You have alluded to having the patient and the customer at the center for much of what we do.

When we put the patient at the center or the customer at the center we often times have to deal with multiple worlds medical world and then the personal world but in reality were not living in multiple worlds. Health is something that we experience on an everyday basis, not just something that happens in a doctors office. It happens in between doctors offices.
Yet when I look at the customer experience I often times have to say whats the world that youre living in. Youre living in a consumer world with your iPhones and iPads at home and so forth. But then whats your health reality. What world do you live in when you bring in the context of health? Why is my consumer experience outside of the health world any different from what it is in the medical world? We need to figure out ways to blend in these experiences. The other point I wanted to mention is more from the physician entrepreneurship angle. And if you look back ten years ago and asked individuals or physicians what is it that theyre looking for from a technology company. If I were going to produce something that told you drug interactions, would that be useful to you? If I could give you a solution that said you could input all of your charts through an online tool, would that be useful to you? And the obvious answer for the customer was absolutely that would be great. So they went back and they spent millions of dollars and they came back and said look at what we built. Here it is, use it. And then the physicians said, no, I dont think so and they said well, why not? You just told us what you wanted and now we built it for you and now you say youre not going to use it. And part of the problem is that we dont design the digital solutions for users and understand the context in which we use these digital channels in the way that we deliver health care in our system. And so, its what I often times term as interference therapy. So weve developed these great technologies and Im not saying that theyre not great, theyre phenomenal technologies. But we never kept the customer experience in mind

when building it. And so now we are basically having to take a step back and say okay how do we bring the e-patient into the equation. How do we bring the e-physician into the mix? How do we bring these customers in and help them design the solutions that actually fit the way they deliver care and then can we move more towards that direction?

MARK BARD
Great. Excellent. Peter Pitts, one of those prolific writers and speakers and everything in between. Im going to force you to talk a little about helping everyone understand that intersection between policy in Washington and how we actually make change happen in a practical feasible manner.

PETER PITTS (CMPI)

Im a former FDA official and Im here to help.

In my opinion, social media must be viewed primarily as a way to advance public education, public health, adherence, compliance all the things we say are really important but always come second to selling product. Were not going to advance the use of social media as long as were stuck in sell mode. When we move towards advancing the public health we begin to revive the mission of the pharmaceutical industry.
The business case is that we know how to sell product. We know how and why television advertising works. We can measure it. We dont understand that people are coming to social media for different reasons not to be sold to but to be part of an interactive conversation and not about a product, but about themselves. Thats the basic difference. And people are sophisticated they know when theyre being sold to and thats not what social media is designed to do. And I dont mean digital advertising, thats something different.

Copyright 2011 Digital Health Coalition. All Rights Reserved.

MARK BARD
Anyone else? Again, youre building the case as a vendor, as a pharma company why are we doing thus?

PETER PITTS
I guess a couple of things come to mind. Firstly, how many people here are in regulatory? That would be nobody. Okay, thats part of the problem. I guess to begin, let me tell you a question I get three or four times a week from the media which is when can we expect FDA guidelines? My answer is, it doesnt matter. And then Ive got to go through a thirty minute explanation of why it does not matter.

responsible for that? And you need FTEs in regulatory as well as marketing. My belief is that health care marketing 3.0 becomes less and less about product specific marketing and it becomes more about a corporate position. And there are a lot of issues, the least of which is the patent cliff and a less than robust product pipeline. Its going to be more about how the company is perceived than the products that it is selling. And most crucially and heres the biggest policy issue that Mark eluded to earlier is that I believe that social media cannot primarily be viewed as marketing to sell product. It cant be seen as the new DTC.

MARK BARD
Well use that as jumping off point; tear that apart. Its a mission statement. Whats the business case for this? Why would I do this?

The two things I am looking for from the FDA, and it should happen in our life time, is one, a definition of what sponsored means and secondly the issue of property owner versus property user. If youre waiting for guidance from the FDA to set you free then you need a better plan.
If it happens it is not going to be of tremendous use to you. If it doesnt happen it remains kind of a convenient excuse -- although thats becoming a less and less unacceptable answer. The second point is that social media is by definition a messy proposition and this is happening within a context and an industry where messy is not liked. In a post Vioxx era we are looking for less ambiguity, brighter lines in the road and that simply is not going to happen relative to social media. Were going to have to accept that were going to actually have to use within a regulated industry -- a messy communications media. And that rankles and it rubs the wrong way and it simply is and it is not going to change. The third thing that is rarely discussed relative to roadblocks to using social media in a really robust and a creative way is that it is not an inexpensive proposition. When we all first saw web sites we went wow! web sites are great. We get to put them up there and then were not going to spend any additional money. You know social media is really at its core interactive and that means you have to have people on your end being interactive. And so clearly you run into to a couple of problems and one is hiring FTEs. And then you have to train them and trust and whos

PETER PITTS
Well, the business case is that we know how to sell products we know how television advertising sells products. When I said the ROI, we know how to measure it. When it comes to social media are people coming to social media to be sold or are they coming to social media to learn and discuss? Thats a basic difference. People are not watching television or reading a magazine or listen to the radio or looking at outdoor to have a conversation. They realize its a one-way conversation.

Theyre in social media for an entirely different proposition and that is to interact, not to be sold to. I mean -- you know youre being sold to as sophisticated as we all are today. Everybody, lets face it, recognizes when theyre being sold to and thats not what social media is designed to primarily succeed in doing. And I dont mean advertising digitally. Thats something different.

Copyright 2011 Digital Health Coalition. All Rights Reserved.

JOAN MIKARDOS
I agree completely and I think ninety eight percent of what Sanofi has done is all around patient education so that ultimately when they are managing their disease and potentially using the products that they have a better understanding of what to do. It is not about product messaging. You have other channels that could really push the product message.

Right now, social media is about engaging, bringing value and helping the patient with whatever it is they need help with - that we could help them with. MARK BARD
Not to put you on the spot but its a year into the future. Youve got to present to the head of the group. Whats in your slide presentation?

And so if we can sort of make that connection of ... if there are social media techniques in which I can better engage with the patient through conversation like educational support, you know sharing experiences across different conditions back and forth. Could I basically - to some degree - address the engagement of utilizing product over time? Its a compliance challenge that many companies have.
Could I move towards better compliance, better adherence with the drug itself, provide validation and credibility behind some of the solutions, the health solutions that are out there and ultimately drive and make the connection towards better outcomes with this enhanced dialogue?

JOAN MIKARDOS
About the ROI?

JEREMY SHANE
Can I address one of your prior questions? Ill also try and address this one. Just a few points. I agree largely with Peter and Joan but I do think that again youve got a different chain in social between what is the information youre putting out under your branded messaging -- whether its your product or your corporate brand or those kinds of things -- and what is your ability to also meet people who are going to be amplifiers of your message.

MARK BARD
Why does what youre doing make sense? Are you showing unique engagements or are you showing the communities you are active in today?

JOAN MIKARDOS
Its not just about measuring activities on the page or wherever we are. Its about the relationships and experiences we are building -even offline. What we do in social media opens the door in a lot of other areas offline for partnerships and things like that.

GAUTAM GULATI
I dont think its a surprise that if you integrate the patient into the dialogue of health care and what should be the conversation between physician, patient, patient to patient and so forth, you ultimately move towards a better outcome.

And so I think part of the ROI of the social marketing is that youre meeting other people or influentials or cultivating people to be influentials so they can translate their own credibility to others. I mean this is the essence of all the reputational, even the game of verification systems that are happening in social.
I think the broader point, agreeing and amplifying what Peter said about the public health kind of mission, is when you look at the large-scale conditions that America faces Alzheimers, diabetes, so many cancer therapies. It behooves

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all the pharma companies to meet as many people as possible, and to help start the patient education process. Not as a patient but just about what health is going to be like and looking forward to the future and getting people into longitudinal studies Because these patient populations are going to help both in the targeting of the therapeutics and the understanding -- the interactions between therapeutics. Most people arent on one medication. Theyre on multiple medications. So I think that part of the ROI that both social and expanding the net can provide is an ROI higher up in the funnel potentially better than some of these other product marketing kinds of techniques and technologies. But it helps to build this broader base of a patient universe and an understanding of how people are using not just your product today -- but other products that are part of their lives today or in the future.

MARK BARD
You could close the loop in theory.

JOAN MIKARDOS
You could close the loop but I think its not always about ROI.

PETER PITTS
Let me pick up on that. Yes, one hundred percent correct. But that raises an interesting question, which is maybe with corporate money but not brand dollars. If I have heard one time relative helping to design marketing programs Ive heard it a million times. Well, is this going to be branded or is it going to be unbranded? Or it needs to be branded or it needs to be unbranded. Or it needs to be unbranded but has to have a really strong brand message. Its foolish and a five year old would laugh at you. Its about being in compliance.

MARK BARD
Okay.

JOAN MIKARDOS
The other thing I think Ill add, that social media brings, is that it allows you to identify needs and gaps that you might be able to address in other places.

MARK BARD
So, in marketing research and then say...

The question is, how can you be in compliance in social and Ill tell you what the answer is, transparency and honesty. Be who you are. Youre not fooling anybody.
You cant be in compliance with a wink and a nod. Really, its not going to cut it on social media. So if you want to tell somebody how to avoid soreness by changing their injection sites, a crucial issue, people talk about it all the time. Will we really need to do that through this third party group? No. Do it on your brands site. Push it out. If its true if its true, its compliant. And I understand where thats going.

JOAN MIKARDOS
Ill give this example. This is when I give my disclaimer this is my opinion and not that of Sanofi. There has been discussion about a reaction or issue they are having with a product. Maybe people are switching to a different product because they cant get around the issue they are having with ours. Wouldnt it be wonderful if we could more proactively address the issue? For example, provide tips on how to use or what to do if this issue happens to you. This can be addressed not only in social media but in other forms of communication. It might prevent people from switching products. How could we more proactively address the issue? I think social media helps bring those things to the table. So its not always about a tangible ROI with social media - that we did this and Ive got that.

JAY GOLDMAN
I think there is a message in there that weve seen in all the other industries that have become involved in social media which is that you used to be able to spend you marketing dollars pushing an inferior product and if you had more marketing dollars you probably did better than your competition. Social media has kind of unraveled that. You cant lie about the value of your product any more because somebody is going to blog about how they bought this toy for their kid and

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then the toy fell apart or whatever it is. And so you have to now switch from spending money to cover up the fact that you have a bad product to actually making better products and using some of that budget that you would have used towards marketing previously to engage in that conversation. We cant do that in a lot of ways because of the conversation piece but I absolutely agree with what Peters saying in that the transparency there is critical in making that transition to the way that people want to be engaged in this conversation. I would say on the sort of topic of the conversation piece social media is an elective medium. We engage in it because we choose to be part of that conversation. None of the other mediums that weve used to communicate in the DTC world before were really elective and the sense of the medium itself was I watch TV because I want to watch it and I read a newspaper because I want to read it. But the way that we as companies and brands communicated through that wasnt elective. It was all interaction driven. The piece of the TV experience that nobody wanted was the ads but that was the way that we could communicate with people.

I just wanted to add one last point. What Joan was saying about ROI, the biggest question we get working in social with clients is ROI. Even if the client that we are working with directly is totally bought in to doing this their boss is only sort of bought in and their bosss boss is totally not bought in. So, somewhere along the way someone has to be able to justify the expense that we were going to make. And I think, Peter said this earlier, its not as cheap as we all thought it was going to be when we started down this road. Theres a lot of expense here. There are FTEs. They are not hiring FTEs and having their agency do it -- which were happy to do -but that doesnt minimize necessarily the cost. I think that what it comes down to in a lot of ways is actually on the ROI side. Joan, I would argue that what you were talking about getting people to not switch away from Lantus has a very measurable ROI. Its just that actually the KPIs we used to measure these things are the old model of KPIs and they dont apply anymore and when you try and justify the ROI of social through them you get a broken equation. So when we talk to clients about broadening their online properties away from a single web site to a YouTube channel and a Facebook channel and a Twitter channel and all that sort of thing, they still come back to you. Okay, but how does that increase my time on site or decrease my bounce rate? Those were measures that were very valid three years ago to measure the amount of engagement you had with your online properties but theyre no longer valid because now if you have somebody on your YouTube channel for thirty minutes watching YouTube videos, they deeply engage with your brand but theyre never showing up on you web site matrix. And we need to stop thinking about the KPIs that we used to use to measure this stuff and start thinking about it more broadly. I think in the Google, Yahoo, AOL panel yesterday AOL had a slide saying that we need to move some of the matrix away from the matrix we used to use for measuring. In fact I believe it was the AOL devil ad unit concept to add emotion and engagement. I agree we used to measure the effectiveness of online advertising by the number of eye balls who looked at it and we all know now that most of those eye balls didnt even see it because of banner blindness and various other things like that. Its the same I think with how we measure the ROI in social.

When you switch to something like Twitter, ignoring for a moment things like sponsored tweets the communication is the part that you like to get in. Thats where consumers want to have that conversation with the brands. They want to reach out to them and say, Im having a problem. What should I do with it? I think thats the piece that we as an industry are struggling the most with when it comes to this whole social piece.
I think the Sanofi folks are doing a great job. They probably come the furthest in allowing comments on some of their properties and being able to answer them. Most often when we have this conversation with our clients it comes down to, well, Ive got five pre approved responses and I can use those pre approved responses and one of them is call the 800 hundred number because thats the catch all response when I cant use one of the other four that Im allowed to use. Its sort of social but to paraphrase a bit of what Peter was saying, its sort of social with a wink.

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GAUTAM GULATI
I want to give a really quick comment in response to your slide question. What would I include? Probably not the only slide but one of the slides is the United Air example with the broken guitar guy. So nobody really wants to be in the shoes of United when that kind of a situation arises from the social media standpoint and so my perspective from pharma -- its not a matter of can we do this? The question is more about how are we going to do this and integrate. Because if we dont our customers are going to end up doing it for us.

Anything else is absolutely irresponsible.

We are all trained that if were at a cocktail party and someone says something bad about our product, that we must capture the remarks and report it back. We cant decide that were off duty or walk away because we didnt want hear it. We have to accept that it is irresponsible not to try to aggressively look for and deal with adverse events in as many new and creative ways as possible. To avoid them by saying its bad for the product is simply unacceptable.

PETER PITTS
The question about ROI, to pick up on what youre saying, is that for years we always talked about impressions. This program generated 32 billion impressions, everybody in India saw it -thats astounding. We used to have clip books back in the days of real paper and it was a deliverable. On television weve had ratings and ratings meant something. Thats how you measured. When you sold a product you sold it within a very specific time frame. Thats how sales reps measured their successes. All thats going to have to change.

JAY GOLDMAN
I totally agree with that. The conversation is happening now anyway. So somebody on a board has already asked about burning on Lantus and a whole bunch of other people have already answered about what they were doing. By not participating we are taking effectively a head-inthe-sand approach and we are saying as long as I didnt see that the conversation was happening it wasnt there.

AUDIENCE Q&A
When you open the door to having a patient say wow, I had burning!!! Now that became an adverse event and your regulatory folks require that you collect that data. One of the things I know from a past life in, as a product director is that they really build a wall out of fear because of how many are out there? If you get other people talking about what they did or you give an answer thats not captured in your PI, not only is that illegal but now youre practicing medicine without a license and so you just open up a lot of doors. How do you get around that?

I would expect theres a time in the not too distant future where the FDA says the technology exists for you to be aware that those conversations are happening and they are happening and the fact that they are happening is a public health issue and so you have an obligation to monitor them and respond to them. And so at that point the issue of how many are out there goes away. But I would say in all the monitoring that weve done with our clients -- there are not as many as youre worried about. Thats the good news. And the even better news is if youre going by the FDA four criteria there are practically none because most of the social

PETER PITTS On the issue of adverse advents heres the short answer -- We have to embrace adverse events. We have to love them. We have to use every possible means to find more and as quickly as possible.

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channels obscure the pieces of information that the FDA is looking for in those actually reportable AEs. So if you actually break it down to that level there are practically none out there.
That may become a question of whether those four criteria need to be updated or not but thats a bit of a different topic. I would say I think at some point we are going to have an obligation to monitor them and then this question closes up.

This is a huge passion of mine to try and figure out because its a huge opportunity to really help patients. We have a lot of information and a lot of times patients dont even know its an adverse event. I think we definitely want to listen with our ears open. Its just a matter of how would you address the issue in the right way.

AUDIENCE Q&A
How about transparency in social media?

PETER PITTS
The first thing is to tell them who you are. Its important to say who you are and who you represent. And at that point theyll either say get the hell off my page or more likely theyll say, okay, Im listening. And then youll be limited as to what you are allowed to say. Something you can definitely say is hey BOB62, saw your comment. You might want to look at this link -which is the link to our branded page with the official FDA PI -- and have a look at the on label indications.

PETER PITTS
A large pharmaceutical company in New Jersey told me a couple of years ago their official policy was not to monitor social media was out of fear of unearthing adverse events. I said imagine you got a call from the New York Times and they said is it true that you actively avoid looking for adverse advance in social media? Is that true? the answer is yes. That makes you sound like a schmuck in the New York Times and it sounds a whole lot worse when your CEO is saying the same thing in front of a congressional sub committee.

JAY GOLDMAN I think its helpful to think of social media as a cocktail party. If you were standing at a cocktail party having a conversation with a group of people who were standing around you and you happen to mention a drug that you were on and all of a sudden a representative from the drug company stepped into your circle at the cocktail party and started telling you things you would find it extremely shocking. A lot of people dont realize when they are having these conversations that theyre having in public.
They think of the safety of the discussion form and the group of people that theyve come to know there as a group of friends and it never really occurs to them that these pages are not password protected and are indexed by Google

JOAN MIKARDOS You cant keep listening with your ears covered. You have to take the good with the bad. What happens when youre passively listening and you come across an adverse event and you want to attempt for follow up, to try and get the other four elements. How would that user feel if you came into their conversation and said: hey, we want to learn more about the issue youre having? Call us or maybe here are some tips to help minimize that. How would that person feel because youre swooping in?

Copyright 2011 Digital Health Coalition. All Rights Reserved.

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and are therefore turning up in social media listening and so we may swoop in out of nowhere with an official response to something.

JOAN MIKARDOS
Its so important. It starts with setting up objectives at the beginning and understanding where social media fits in the bigger strategy. Not just with the digital strategy but with your overall marketing strategy. Where does this fit into that? and this is what we expect to get from that? Thats the best advice I could give having clear objectives, understanding where it fits in the overall marketing mix and then checking in often to see if you are hitting those early indicators.

The advice that I would give is the same advice that I would give if you ask me how to network at a cocktail party. If you want to become part of that conversation you have to become part of the conversation. You cant drop in and have random outbursts about your product or why people should listen to you. What you have to do is become part of the community. And so if there is a community of people who are in your therapeutic area and they are regularly having conversations online you need to become part of that community and become a regular trusted member of it in order to become part of that conversation. The scary part about that is, yes, its very time consuming. But that is the nature of being involved in a social community.
So become part of the conversation, visit regularly, comment on things where youre allowed to comment on and then when they do have questions they will much more instinctively trust you to provide an answer to them.

JAY GOLDMAN We give advice to our clients. We often get asked we need a social media strategy. We say you dont need a social media strategy because social media is a tactic. You cant have a social media strategy any more than you can have an SMS strategy or an email strategy. What you need to do is figure out which strategic imperative you have that social media can help you to achieve and make sure that in implementing the tactics that are related to social media, they ladder up to KPIs that relate back to strategic imperatives.
If your management has given you a strategic imperative to grow your patient base by X percent then we can look at social media tactics that will help you achieve that and make sure that the things that were measuring relate back to that measure so that so that when you go to report on it to your management youre able to report on numbers that theyre actually expecting to hear. If you start going back to them to report our retweet rate is X percent this week. Theyre just going to look at you like, what! But if you go back and say through Twitter we were able to engage people in a conversation that lead to an increase in our customer base -- or whatever the matrix is. Theyll be much more able to relate to it.

JOAN MIKARDOS
I just want to add, be human because I think thats the most important thing. Be human.

AUDIENCE Q&A
How do you set up and monitor success metrics?

Copyright 2011 Digital Health Coalition. All Rights Reserved.

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JEREMY SHANE
I totally agree with what everybody said. From a publisher perspective ... share those metrics with the publishers so that we can help you achieve results from some of these different kinds of tactics. Too often the ultimate objectives and how your particular tactic fits into your larger strategy is completely opaque to us. Its about how many people go to your pharma web site or take another action in your branded area and if we can understand that we can also help design leveraging kind of the approach that Peter talked about, techniques to leverage social and also share in the success with the upside and the downside of how those tactics contribute to the overall experience that youre looking to achieve. www.digitalhealthcoalition.org www.facebook.com/digitalhealthco www.twitter.com/#!/digitalhealthco Mission The Digital Health Coalition, a nonprofit organization with 501(c)(3) status, was created to serve as the collective public voice and national public forum for the discussion of the current and future issues relevant to digital and electronic marketing of healthcare products and services. Vision By engaging multiple and diverse stakeholders-including the pharmaceutical and biotech manufacturers, physician and patient groups, advertising agencies, health information providers, internet search companies, medical technology companies, employers, health plans, public health agencies, academic and research institutions, and public sector stakeholders, the Digital Health Coalition's vision is to identify and then recommend specific actions that will inform digital healthcare communication and engagement for the benefit of the public at large. Further, the Coalition's projects and position statements aim to educate the public through the distribution of informational materials that will be widely reported in the media and referred to in setting of state and national digital health communication standards.

MARK BARD
Thank you, panel.

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