In my last column, I discussed how patients use social media to access health information (October 2012, p. 22). To summarize, some basic trends are strikingly clear. Women are generally more concerned about their health than men, and seek information from both the Internet and their physicians. It is also clear that women make most of the health decisions for their families. Additionally, we know that many patients use social media to connect with one another to share their experiences with both rare and common diseases.
In this month’s column, I’ll take a look at industry participation in social media and how it is used internally and with patients. Currently, we know that approximately 35 percent of 18- to 34-year-olds use social media to access some kind of health information. Older patients are more reluctant to use the Internet and are much less likely to use social media for any type of health information. Patients of all ages continue to rely heavily on physicians for health information, according to digital marketing agency TopRank Online Marketing. Patients turn most frequently to their personal or primary care physicians, and then to specialists, for information. Notably, at the very bottom of the list of popular sources of health information are television and magazine advertisements, according to searchforhealth.net.
Google, Yahoo, MSN and ASK are the main search engines used to locate information. Health care specialty search engines such as Healia, Medstory, Fealth, Kosmix and Healthline are not heavily utilized by the general public. The main focuses of patient searches are symptoms, specific diseases, treatments and conditions. At this time, there are relatively few searches directed toward insurance companies, doctors, hospitals and pharmaceutical companies.
Additionally, patients are not yet turning to physician rating systems in large numbers. With the changes coming in health care delivery, such as Accountable Care Organizations (ACO), this may become a moot point anyway, with physicians available to patients limited to their specific ACOs.
Direct Marketing Campaigns
The pharmaceutical industry has been the primary source of direct marketing campaigns since the Federal Drug Administration (FDA) allowed direct marketing to patients nearly 15 years ago. Expenditures are huge. Pharmaceutical promotions have grown from $11.4 billion in 1996 to $29.9 billion in 2005 (N Engl J Med. 2007;357:673-681). Current estimates indicate expenditures in direct marketing are increasing by 20 percent each year.
Direct marketing is usually reserved for new drugs that have been approved by the FDA over the past year and are used primarily for the treatment of chronic illness. This can be particularly problematic because many of the side effects have yet to be defined during that first year. Vioxx (rofecoxib) is a good example of a drug that was heavily marketed directly to the public and then had to be recalled due to high risks of heart attack and sudden death.
Other medications that have been widely directly marketed to patients are proton pump inhibitors and sleeping pills. In 2005, two drugs alone, Lunesta and Nexium, topped $432 million dollars in direct advertising to patients—costs that must be covered by their manufacturers. In 2005, then-U.S. Senate Majority Leader Bill Frist (R-Tenn.) called direct marketing the “fuel to America’s skyrocketing drug costs.”
Another type of direct marketing technique, one that does not use social media, involves distribution of free pharmaceutical samples dispensed through physicians’ offices. The regulatory requirements associated with tracking these medications are significant. If your facility is Joint Commission accredited, you must track all meds dispensed to patients, including lot numbers, in case there is a recall. These regulations have become so onerous that many offices no longer dispense samples, a change that may make direct marketing through social media more popular.
Some segments of industry have begun to use social media in an entirely different way—through their own intranets. An intranet is a private, online environment that provides a platform for improving communication and sharing knowledge across an organization. These networks are open only to members of the organization, and the platform can be built with the features of social media for information sharing.
However, such a network may involve a dramatic shift in an organization’s management style. Senior management must completely support this organizational shift, because the organization’s issues are hanging out there for all members to see. This setup can be very uncomfortable for anyone used to a hierarchical management structure, and unsettling for members of some cultures, because everyone connected through the intranet can contribute. In this environment, all comments are welcome, and the value of the content is determined by everyone in the organization.
The backbone of any organization is its people and its knowledgebase. Using social media in a closed intranet environment allows members to find out who knows whom and what, which can improve the organization’s function. A profile of the employees, including job descriptions and areas of expertise within the organization, is crucial for this function. This type of management is still in its infancy and should be attempted with caution, bearing in mind its many downsides.
In my next column, I will discuss issues around social media and health care professionals. There are some very real traps that come with “broadcasting” seemingly innocent information and experiences using this new form of communication.
Rodney Lusk, MD, is director of the Boys Town Ear, Nose and Throat Clinic and Cochlear Implant Center at Boys Town National Research Hospital in Omaha, Neb. He has been working with EMRs since 1996. He may be reached at firstname.lastname@example.org.