“IS DIGITAL MARKETING DOING MORE HARM THAN GOOD FOR PHARMA?

Assignment submitted to Jamia Hamdard in partial fulfilment of the requirement for the award of the degree of

MASTER OF BUSINESS ADMINISTRATION

(PHARMACEUTICAL MANAGEMENT)

DEPARTMENT OF HEALTH & HOSPITAL MANAGEMENT

SCHOOL OF MANAGEMENT AND BUSINESS STUDIES

JAMIA HAMDARD

(HAMDARD UNIVERSITY)

KUMARI ALAKNANDA & AYUSH KHANNA

2018-2020

UNDER THE SUPERVISION OF MR. UBADA AQEEL

TABLE OF CONTENTS

1
 S NO. TOPIC PAGE NO.
1 ACKNOWLEDGMENT 3
2 INTRODUCTION 4
3 SOCIAL MEDIA- A USEFUL TOOL OR A 6
DISTRACTION IN PHARMA PROFESSION
4 HOW SOCIAL MEDIA IS TRANSFORMING PHARMA 9
AND HEALTHCARE
5 FINDINGS 12
6 CONCLUSION 16

ACKNOWLEDGEMENT
It was a great opportunity for us for learning and professional development. We are so lucky that we were
assigned with this assignment.
We would like to thank our supervisor Mr. Ubada Aqeel for their guidance and contribution in helping us
achieve the goals of this assignment. Their assistance has always been an important part in improving the final
document.

Sincerely,
Kumari Alaknanda & Ayush Khanna
JAMIA HAMDARD
NEW DELHI

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INTRODUCTION

Pharmaceutical industry in India is one of the most growing markets. In present digital times, everything is going
digital. With the increased use of internet in every field, users are also searching health related information
online. With the continuous rise of internet users in India, pharmaceutical companies have a potentially large
‘online’ market that they can influence using social media. Most of the companies are present on the digital
platform. Social media is one amongst the most preferred digital marketing tools. The pharmaceutical companies
have made information related to drugs, their pricing, disease awareness campaigns and other such data available
on their website, social media platforms and blogs. The consumers search online for drug prices, drug brands, its
availability, side effects, substitutes available etc. Pharmaceutical companies are developing their marketing
strategies on the basis of data collected online from their consumers. Most of the marketing professionals used
Social media for their company's brand creation and were neutral to use social media for professional
communication. However, there is lack of privacy and data reliability were main concerns in the use of social
media by marketing professionals. The collected data by pharmaceutical industry could be used as repositories,
pharmaceutical companies can also use such data to gain an improved insight in the needs of patients and doctors.
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Social media can make the consumer centric model of the Indian Pharmaceutical industry stronger by gaining
market and customer insights. Thus, pharmaceutical companies should accept social media and add it to their
marketing strategies.

Social networking sites (SNS) have become commonplace in our lives, and, for many daily activities, the
pharmaceutical industry, too, is tapping into this new media. Within the consumer industry, social media is now a
key component of sales and marketing strategies. The pharmaceutical industry, however, has a number of barriers
that other industries do not, such as government compliance and regulation.

In a recent Harvard Business Review article (Miller & Christakis, 2011), the authors explained that tapping into
the “right” key opinion leaders (KOLs) has long been the sales and marketing strategy for pharmaceutical
companies. They also state that social networks play a key role in doctors’ prescribing choices:

Even after a drug has been proven effective, doctors tend to be slow to recommend it, and often wait until other
doctors they trust start doing so. Studies have shown that physicians were much more likely to prescribe the
diabetes medication Januvia if they had Januvia adopters in their networks—an effect that extended to three
degrees of separation (a colleague’s colleague). Social connections can also work the other way, turning
physicians away from certain drugs. Sales of Pfizer’s cholesterol drug Lipitor declined precipitously when a
generic version came on the market: interconnected doctors switched their prescriptions almost simultaneously,
like a flock of birds changing directions.

One consultant from IMS Japan certainly supports the research from Miller and Christakis, by stating that “the
reason why SNS is very effective in the pharmaceutical and medical markets is, for example, because medical
environment is highly specialized and closed, key opinion leaders’ voices tend to gain recognition in that closed
circle.”

A product manager for Januvia Japan described his experience as follows:

It is probably true that physician-to-physician communication helps the drug to be used widely so quickly. The
communication has been done through word of mouth, presentation, publication and the Internet. However, it is
not only physician-to-physician but also patient-to-physician communication which had great influence. Also,
after the launch of Januvia, there was a lot of media coverage on the new diabetes drug.

However, some people within the pharmaceutical community do have concerns. At the Eye for Pharma
Conference in Tokyo a couple of years ago, the market research company Creation Healthcare already reported
that “the changing landscape seems to have raised concerns about doctors’ reputation due to the fact that their

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patients now have access to information they may not be aware of, or because of new behaviours that affect the
doctors’ authority (such as post drug prescription research, ratings on websites, etc.).”

SNS will continue to play an important role in the pharmaceutical industry in Japan through educating and
engaging the patient community, as it provides a different channel to educate and engage with the consumers.

SOCIAL MEDIA – A USEFUL TOOL OR A DISTRACTION IN PHARMA PROFESSION?

Social media is part of everyday life for many healthcare professionals (HCPs) who use it alongside traditional
communication channels for scientific exchange and debate. The benefits of facilitating the transparent and
credible exchange of medical publications-related information are clear. Insights from online discussion also
provide new channels when looking at treatment landscapes for disease areas. The question for medical
publication professionals is how to communicate through social media and how to navigate the unique
compliance, trust, and content challenges that social media poses.

Why should medical publication professionals engage in social media and where is the added value?
Social media can be one of the quickest ways to gather information on myriad topics, and its use is increasingly
extending into the professional setting. In the broad social and political sphere, where some social media
influencers have millions of followers, it is easy to see how far reaching content can be and the impact it can
have. Social media is widely used to share publications-related content, from sharing links to articles or bite-sized
content such as infographics or video abstracts, to discussion of article content. For journals and the

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pharmaceutical industry, social media represents an opportunity to enable publications to reach a wider audience.
Once in the social media sphere, scientific exchange and debate by HCPs demonstrate the frictionless sharing of
information, which is social media’s greatest strength.

Social media can also be used to monitor the online footprint of newly published research, allowing level of
interest (number of retweets, topics discussed) to be gauged. These social media interactions have given rise to
their own form of metrics, Altmetrics and PlumX, for example, which provide article-level information on overall
engagement through social media channels. The scientific exchange and debate regarding publications that can
take place on social media is also a rich source of insights for publication professionals. What is being discussed?
Who is discussing it? What scientific questions arise from it?

What are the current challenges for medical publication professionals?

Social media’s benefits for publication professionals need to be considered in the context of limitations and risks.
For example, the more in-depth debate and discussion that works for HCPs might not be appropriate for industry
or journals, for whom fair balance is critically important.

Social media is designed for the quick and easy consumption of information, so it is a valuable tool for enhancing
reach by providing simple links to content. However, communicating content within social media posts requires
greater consideration. How many times have newspapers used headlines like “Bacon causes cancer!”? Similarly,
with the limited word count of social media posts, there is the risk of oversimplification. Certainly, there is
perception in the pharmaceutical industry that social media is associated with a loss of nuance and oversimplified
messaging, which can open it up to litigation.

Even with pharmaceutical companies slowly increasing their use of social media, many are reluctant to fully
engage out of fear of litigation and perception of overpromotion. As such, the U.S. Food and Drug Administration
(FDA) has published guidance on the use of social media for the promotion of therapies; it recommends that any
social media activity promoting a drug be accurate and balanced and include both the benefits and most serious
risks of the products. Due to these compliance limitations, pharmaceutical companies are often reluctant to go
beyond sharing clinical trials/articles, but there may be instances in which it could be necessary to become
involved, such as if a conversation about a particular product strays into misinformation. Medical communication
agencies can help by highlighting discussions to their clients and providing suggestions for how to respond,
although any action should come from the pharmaceutical company and would require medical, legal, and
regulatory approval. Publication professionals must ensure that any material created for social media be faithful
and unbiased summaries of the content; however, the question of just how much publications stakeholders should
get involved in any commentary on a publication still remains. Despite these challenges, social media offers a
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rich vein of potential interaction with HCPs and even patients that publication professionals traditionally struggle
with, and it is important to understand how best to do this.

Any material created for social media must be accurate, balanced, and based on robust scientific data.

What can medical publication professionals learn from the social media dialogue on publications?
Social media offers opportunities to monitor conversations about articles in real time, allowing publication
professionals to evaluate if they are engaging the right audience and what that audience thinks about the data.
Social media may also provide ideas for further research that may not yet have occurred to the authors of the
publication. This can offer useful insights and collaborations that can be considered when developing or refining
future communications and educational strategies, which is already happening in the academic world. 1 By regular
monitoring of social media user engagement, publication professionals can develop a fuller understanding of who
are favourable towards the data and who are not, why they may feel that way, and where additional medical
education is required.

Recently, ISMPP conducted a member survey to understand the awareness, knowledge, and use of social media
among publication professionals.9 While there was widespread awareness of social media and its accompanying
metrics, few understood how to evaluate reach and engagement. 9 Most responders were interested in those who
engaged in social media and which sources generated the most interest; however, few responder organizations
indicated they monitored social media activity regularly.9 Given the value that monitoring social media brings to
understanding what HCPs think about the data in specific articles, this seems like a missed opportunity.

Understanding social media timing is also an important consideration in monitoring social media. 10-16 Studies of
Twitter use have shown that social media is most effective in the first month of a publication, when interest in
new data is at its highest.14 This impact also seems to increase with coordinated Twitter strategies; when journals
tweet about particular articles or publishers encourage journal Twitter chats, the number of hits to journal sites
increases significantly.10,16-18 The importance of journal engagement cannot be understated, as journal tweets that
share links to publications were observed to have higher engagement than tweets from other sources. However,
journal tweets, particularly from lower-tiered journals, seem to be underused and may represent another missed
opportunity.16 More so, the impact on engagement greatly increases if a publications tweet is used with other
media, such as blogs, news feeds, and other press. 10,12 It is, therefore, important to not only understand when to
monitor social media activity, but also to understand journal policies on social media presence when submitting
articles.

What should social media content look like?

The time that HCPs have to read and access journal articles is ever diminishing; this is where social media really
comes into its own. Social media can present HCPs with the latest research through tweets or links, which enables

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them to rapidly scan the latest research in their areas of interest and decide whether they want to dig deeper.
Having content that is clear and “snackable” through interesting visuals may further pique readers’ interest and
lead to increased traffic to publications. Other media, such as podcasts, video abstracts, and infographics, is
important to consider, as the style of their content nicely reflects the style of those sites frequently visited by
some HCPs, such as Instagram and Reddit. 6 In the future, it is likely that social media content that complements
the style of each publication will become the norm.

The benefits of social media in extending the reach of communications are clear, and there are some simple
approaches that can enhance this, such as more consistent tweeting from journals about new content or using
accompanying content like plain language or visually interesting summaries. Medical publication professionals
should be thinking about such aspects as part of publication tactics. By looking at how HCPs interact with
content, publication professionals can gather insights on the dialogue, user behavior, and preferences, which can
be considered when developing future strategies.

HOW SOCIAL MEDIA IS TRANSFORMING PHARMA AND HEALTHCARE

Social media has moved beyond being a fashionable word to one that is drawing renewed attention from the
pharma and healthcare industries. The power of these tools and the impact that they can have not only on brand
perception and, effectively, on sales, as well as the increasing interest of the regulators in social media is resulting
in this shift. In addition, tools and technology and the growth of the data sciences industry have proven to be
powerful enablers. As patient centricity becomes the cynosure of attention, the need to capture their views
becomes necessary. Social media brings in a pragmatic component to clinical trials, supporting the world of
evidence-based medicine (EBM). Patients themselves want to draw more informed decisions and want to be
participants in the decision-making process on how their health is going to be managed.

It has been observed in studies that of the more than 74% of Internet users that engage on social media, 80% are
looking for health information, 1 with 90% of the younger media-savvy 18-to-24 year-olds 2 claiming that they
relied upon this source, using it twice as often as the more senior population. They shared health-related

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conversations and patient stories on diverse topics such as how someone coped with a chronic condition, views
on diet and exercise, and their choice of physician.2 The most accessed online resources for health-related
information included WebMD (56%) and Wikipedia (31%). 3 Patients wanted doctors to actively share updates on
the disease, new pipeline compounds, their experience with different drugs, etc., on social media and 60%
claimed that they trusted what the doctors were posting. 4 It becomes all the more important for healthcare
professionals (HCPs) to share accurate information and timely updates with the patient community. It was not
only patients who were leveraging social media, 60% of HCPs were also actively watching what their
counterparts are sharing on health-related issues. Doctors themselves seemed to truly believe that social media is
impacting the quality of care. Forty percent of patients also relied upon social media to assess how others were
dealing with chronic conditions.2

All of these situations have led to the development of numerous online patient communities such as:

 PatientsLikeMe — The largest online patient community, spanning 500,000 members 5 and covering over
2,500 conditions. It partnered with the National Quality Foundation to leverage social media to assess the
quality of life in communities with multiple sclerosis (51,000 members), chronic obstructive pulmonary
disease (2,500 members), and rheumatoid arthritis (10,000 members). They also compared patient-
reported outcome (PRO) data generated from specific tools provided to these communities. Analyses
showed that the PROs needed to use more “patient-friendly” language to describe the symptoms and it
was the first time that such a large-scale study had been performed for an assessment of this nature. 6

 23andMe — An online patient community to which the FDA granted authorization to market a direct-to-
consumer genetic test, the Bloom syndrome carrier test; customers who purchase their personal genome
service (PGS) would receive their ancestry information and uninterpreted raw genetic data.7,8

 Iodine — A site which combines pharmacist expertise, FDA data, and real-life experience from patients.

 Smart Patients — A closed online community which provides a platform for patients and caregivers to
connect amongst themselves and find disease-related guidance and answers that may be scant in other
formal channels.

 PatientsKnowBest — A British social enterprise which integrates with the National Health Service
(NHS) network and allows patients control of their own medical records.9

 Doctor online networking communities — Include those such as Doximity (has 70% of US doctors as
verified members);10 Sermo (with over 800,000 members across 96 specialties); 11 MomMD (women
doctor’s networking site, 11,000+ active members);12 and many more.

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Geo-based social media strategy

There is a whole spectrum of social media services being leveraged by pharma and healthcare, ranging across
listening and analytics, marketing, and engagement. Companies are designing geography-based social media
strategies based on the audience that they are targeting. Novartis, for example, thus engages with the public for its
brand Gilenya® (the once-a-day pill developed to treat multiple sclerosis) through a dedicated handle on Twitter,
@GILENYAGoUSOnly. The introduction section of this Twitter handle clearly calls out that it is only for a US
audience and also sets forth other guidelines of interaction, such as the response window, how to share personal
details, and also the discretion Novartis would practice in responding or not responding to certain tweets. 13
Internally, for a pharma company, this means the need for increased harmonization in social media efforts across
countries and regions, while staying compliant with local regulations. When it comes to listening, social media
tends to be more porous and it no longer matters, for instance, where an adverse event (AE) was reported, as it
can find interested audiences anywhere in the world. But engagement is a different world altogether, as it has to
be contextualized to the specific user, geography, local regulations, and so on.

More AE traffic?

The likelihood of generating excess AE traffic has been one of the reasons that often dissuades the pharma
industry from leveraging social media listening. The four basic elements for submission of an individual case
safety report to the FDA include an identifiable patient, an identifiable reporter, a suspect drug or biological
product, and an adverse experience or fatal outcome suspected to be due to the suspect drug or biological product.
Pharma companies are required to publish events reported on company-sponsored websites. However, if they do
become aware of an event that has been reported on another site, they should review it and determine if it requires
to be reported on theirs. In recently reported industry views on the issue, Abbott felt that the entire web should be
monitored for AE reports, while AstraZeneca did not align with this approach. Bayer allowed the Pharmaceutical
Research and Manufacturers of America (PhRMA) to speak for the company, the group’s stand being that only
company-sponsored websites should be monitored and the events meeting the reporting criteria defined by the
FDA should be posted, provided the reporters were privately contactable, so as to respect patient privacy issues.
Lilly also observed that national privacy laws needed to be respected and follow-up with patients on these reports
should be avoided. Merck & Co. cautioned that social media reports could result in an AE being blown out of
proportion, citing the example of Sanofi, which had to shut down its Facebook page when a patient who reacted
to cancer drug Taxotere  posted a flood of comments about experiencing hair loss, triggering major reactions
from the larger patient community. Sanofi did reopen the page later, but included terms of use. Lilly
recommended that the FDA create a separate category for events reported on social media and also conducted a
pilot study to demonstrate that the considerable efforts invested in monitoring social media for AEs did not yield
corresponding results.14

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The most significant challenge faced by pharma was identifying the reporter of AE information on social media
sites. The FDA defines an “identifiable reporter” as one who is privately contactable. While Novartis believed
that additional demographics were important, AstraZeneca felt that an email ID or even a Facebook contact was
enough. However, both companies agreed that Aes collected from organized data collections systems should be
considered as “solicited,” whereas the rest should be treated as “spontaneous” reports. Though the European
Union (EU) does not mandate the monitoring of social media for Aes, it does require that events that have been
observed should be reported. This may change as observations from the WEB-RADR (Recognizing Adverse
Drug Reactions) project gain traction in the EU. Launched in September 2014 by the Innovative Medicines
Initiative, WEB-RADR, a €2.3 million, three-year public-private project, is responsible for developing a mobile
application for reporting adverse drug reactions (ADRs) to regulatory bodies in the EU region. The mobile app
would help evaluate the potential of social media data in identifying safety issues.15

It has also been observed that in a study conducted on AE reported for Lipitor ® (atorvastatin) and Meridia®
(sibutramine) in the FDA Adverse Event Reporting System (FAERS) database and on AskaPatient.com (a
patient-support group website), the majority of AE reports on social media came from a younger population and
focused on milder Aes on AskaPatient.com, as compared to those reported in FAERS.

FINDINGS

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 8%
Aware

Not Aware
46%

54% Aware Of Use

Not Aware Of Use

92%

Digital Population in India as of January,2018

A recent report by IMS Health suggests although half of the top pharmaceutical companies in the study actively
participate in social media (Facebook, Twitter and YouTube), investment in this area remains low relative to
other industries. As compared to other industries, the strategies employed by pharmaceutical companies to
engage with social media are at best low risk and less innovative than those used in other industries. In terms of
social media advertising, as mentioned by Facebook likes, Novartis has been reported to have topped the charts
as compared to GSK, Dr. Reddys Labs, Sun Pharma and Piramal (July 2019). Novartis also has the maximum
followers as compared to others.

Healthcare and especially pharmaceutical companies can have a potentially large ‘online’ market that they can
influence using social media. Mcdaid and Park report that 90 per cent of all Internet users in India search for
health-related information with around 70 per cent searching for specific medicine related information. With such
a large number of internet users searching for medicine and health related information, a lot of information is
generated by patient on various social media which are both interactive and cost effective when compared with
offline advertising.7 This information includes patient feedback, sharing of experiences etc. Companies,
therefore, stand to gain invaluable customer/ patient feedback by just listening in on conversations conducted by
patients on social networking websites and contributing wherever applicable.

However according to a study by the IBM institute for Business Value, “Fade or Flourish: Rethinking the role of
life sciences companies in the healthcare ecosystem”, while most pharmaceutical companies have started
alternative channels such as the internet, they continue to rely on push marketing instead of communicating with

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the customers about the issues they face. The study reports the internet is not that effective when it comes to
Sales and Marketing. The content on hundreds of distinct websites is often old and mono-directional in
communicating.

Pharmaceutical companies can acquire a vast amount of data from various social media, used by their customers,
which then can be used for formulating sales and marketing strategies.8,9 However, an IBM study which
surveyed Chief Marketing Officer (CMO) showed that 100 percent of life sciences CMOs felt ill-prepared to deal
with the vast amount of information. Additionally, many of those interviewed from life sciences (including
pharmaceutical) companies (90 percent) were worried about the impact of social media. However, approximately
73 percent of them indicated they planned to increase the usage of social media technology over the next few (3-
5) years to manage big data and about 35 percent were actually planning to use social media parameters to
measure success in marketing.

1. Perception of pharmaceutical industry professionals of social marketing

92% of industry professionals (product managers and consultants) reported that they were aware of social
marketing and 46% stated that their organization did use some form of social media communications.

Respondents were then asked about their views on the use of social media for communications with doctors and
patients. 60% were positive while 12% were negative. 28% were neutral about the usage. Of the 60% who
viewed the usage positively, only 1/5th was highly positive. No one was completely negative (Figure 2). Only
4% felt worried about the usage

12
Very positive 16
Positively willing 8
Slightly willing 12
Mildly positive
Cautious 12
28
Neutral
Mild negative 8

0
Critical Paranoid 4
Completely negative
0

View of marketing professionals on

0 the use of
5 social
10media for
15 communications
20 25 with
30 doctors and patients

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88% respondents felt that social media could contribute to make the consumer centric model of the
pharmaceutical business stronger. 88% respondent also felt that social media could have a positive impact on the
image of pharmaceutical companies. No one thought the impact of social media could be negative.

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Yes

No
88
Positive

88
Neutral

Negative

12

Perception of industry professionals of the contribution of social media to consumer centric model of the
industry (cc) and the image of the industry.

2. Perception of Advertising professionals

Not surprisingly, all agencies had heard of social marketing. 41% also reported that they knew about
pharmaceutical companies who used social media marketing.

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0%
 41%
Not Aware

Aware of Use
59%
Not Aware of Use

100%``

Awareness about various social media and their use in the Indian Pharmaceutical Industry

Of the various social media, social networking sites and blogs and micro blogs were the most well-known among
advertisers. Virtual communities, virtual game worlds, content communities and collaborative projects scored
less.

Virtual Communities 12

Virtual Game Worlds 12

Social Networking Sites 25

12

Content Communities 23

Blogs and Microblogs 16

Collaborative Projects
0 5 10 15 20 25

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CONCLUSION

Overall it appears that while social media do find acceptance in the pharmaceutical industry, no one was
willing to depend on these totally. The different stakeholders were in favour of a combined approach i.e., a
one-one sales force supported by the social media. There was a high degree of wariness associated with the
use of social media for pharmaceuticals purposes. There were concerns about the lack of privacy during the
use of social media and the reliability of information put up on social media, thus stressing a need to put
regulatory guidelines in place for this kind of communications when used by the pharmaceutical industry.
These media can be used as a repository for information from doctors who were quite willing to use such
media. Pharmaceutical companies can use such data to gain more insight in the needs of patients and doctors.
This would help them in projecting their brands in a better manner and retain customer loyalty. They can
provide information needed both by doctors and patients in a fruitful and satisfying fashion. Social media can
make the consumer centric model of the Indian Pharmaceutical industry stronger by gaining market and
customer insights. Thus, pharmaceutical companies should embrace social media whole heartedly and make
them part of their marketing strategy while conforming to the regulatory guidelines in place.