Hospitals Pushing the Envelope with Social Media

This article also appeared in odwyerpr.com.

The Line Between Marketing and Education Begins to Shift

The usually conservative hospital sector has started to embrace social media. Whether it's increasing competition, the need to keep patients coming through the door, reputation management or recruiting, hospitals are turning to these new web-based tools for assistance in increasing numbers. Ed Bennett, the director of Web Strategy at the University of Maryland Medical System, keeps tabs on this: there are 128 hospitals that have YouTube channels, 87 with Facebook pages, 140 have Twitter accounts and 23 have blogs. It's notable but still a minority. There are over 5,000 hospitals in the US.

In the StarTribune (Minneapolis-St. Paul), Chen May Yee spotlighted how "Mayo Turns to Social Media to Reach Out to Potential Patients." Lee Aase, manager of Syndication and Social Media, has helped to give the famous medical center an even greater public platform. Indeed, it was reported that he has developed so much expertise that he "travels the country to speak at conferences and runs his own virtual Social Media University, Global (SMUG), a web site with courses such as Blogging 101." The newspaper called him "a rock star in that space where social media and health care marketing overlap."

Two good examples of appropriate and valuable uses of the technology include Innovis Health in Fargo, which used Twitter to help people find the safest route to the hospital during the recent floods in North Dakota, and the University of California at San Francisco, which used YouTube to reach out to potential patients for a clinical trial that had difficulty enrolling volunteers.

But I see another side to this coin. In "Webcast Your Brain Surgery? Hospitals See Marketing Tool," Pam Belluck of The New York Times reported on a surgeon who was tweeting during the removal of a kidney tumor. He said, "Gosh, this is big" and "Could I have picked a harder case for this?" The hospital's web services manager said, "some bleeding needed to be controlled," but "we just tweeted right through it." Maybe there is some educational value in this but my first reaction was "please stop tweeting and give your full attention to the patient!"

Methodist University Hospital in Memphis transmits live webcasts for some surgeries. After seeing an advertisement for an upcoming craniotomy, a man called to volunteer and was accepted to be a patient. He said that if the doctor "was operating live on the web, he must be pretty darn good." What the hospital told the Times, however, was that a back-up video is always at the ready. "If something unforeseen happens and you need to cut away from the surgery, you can fall back on your previous surgery." OK, you want to spare your audience (and the family) from potential tragedy but there is something bait-and-switch-ish about this.

As we've seen, some of the most venerable names in patient care are joining other industry sectors in engaging the public. But does that make it right? Should hospitals behave like consumer goods companies?

The biggest questions, in my view though, revolve around ethics and value:

1. Is the particular use or application ethical? While hospitals take great care in protecting patient confidentiality, more care needs to be applied to marketing and public relations. Sure, sharing information is great. But Jeffrey Kahn, a University of Minnesota bioethicist, pointed out in the Times article that, while there is "value in demystifying medical care," the ability to use new web technologies "creates an aura of sophistication and high-tech ability" that may not represent the "quality of care at the hospital."

2. Is the particular use or application creating any value? Just because social marketing tools are cheap to implement doesn't mean they should always be utilized. The "we have nothing to lose" argument does not apply. And, even though web conversations are occurring anyway doesn't mean you must always be an active participant. Clearly, the people behind the social media push are gaining notoriety but less clear is the pay-off for the hospitals they represent. For every patient that might be impressed, there may be others who are dismayed.

It's a fascinating time in the world of marketing and communications. Yet, while we create new tools and channels, we'll need to ensure they accomplish what we intend.

A Spokesperson Goes Off Track

Remember to Keep an Ear to the Rail

Brands have several options when it comes to gaining endorsements. Among them are experts, celebrities, and people with actual success stories. In the pharmaceutical industry, the last example would be happy, grateful patients. Patient spokespersons have proven effective in communicating key messages authentically.

But not always. In "A Celebrity Patient's Backing Turns Sour for Drug Company," by Shirley S. Wang in The Wall Street Journal, we learn about Andy Behrman and his relationship with Bristol-Myers Squibb. Mr. Behrman is a well-known figure; he chronicled his life with bipolar disorder in "Electroboy: A Memoir of Mania," published in 2002. Reports indicate that BMS paid him $400,000 in 2004 and 2005 to discuss the benefits of their blockbuster drug, Abilify(R). Mr. Behrman appeared in videos, at BMS events, and in various media interviews, sharing how Abilify was life-changing and had no side effects.

Now we hear from Mr. Behrman, whose non-disclosure agreement has lapsed, that what was reported wasn't true. He stated that he experienced side effects worse than any treatment he had tried and stopped taking Abilify within the first year.

Working with endorsers can be tricky, but BMS reportedly said that every collaboration, except for this one, has been positive. Indeed, the first celebrity campaign—for the arthritis drug Voltaren(R)—gave CIBA-Geigy (now part of Novartis) quite a pain in the late 1980s. Baseball legend Mickey Mantle, who wasn't taking Voltaren and didn't disclose the corporate relationship, went about as far off message as one can go by claiming the drug can cure hangovers!

The WSJ article provides insights on how to minimize the chances of being surprised and disappointed by a patient spokesperson. Here are some principles to consider:

• Don't talk in absolutes. When he switched to Abilify, Mr. Behrman said that all of his drug side effects "went away." This assertion was made repeatedly and never should have been sanctioned by BMS and its PR firm. While Abilify may have a better safety profile than some other atypical antipsychotics, it carries a long list of side effects and warnings on its label.

• Ensure authenticity. The BMS contract didn't require Mr. Behrman to take Abilify yet there he was talking up the benefits.

• Conduct due diligence. Mr. Behrman signed a waiver allowing his doctor to share his medical records but BMS never checked them.

• Communicate good news and bad. Although Mr. Behrman said he was in almost constant contact with BMS and its PR firm, the bad news that he was, in fact, experiencing some side effects and stopped taking the medication was either ignored and/or never brought to a higher level.

• Be prepared to jump the rails. It's hard to pull the plug on a program, an investment, but that's what we must do when things go dangerously off track.

Staying the course may damage BMS's reputation, and Mr. Behrman's reversal might raise questions about his motives. His website includes a link to The Daily News gossip column, Side Dish, from November 19, 2008, which stated that Brad Pitt and Matt Damon might be interested in his new book, Adventures in the Drug Trade: I Was a Big Pharma Pusher. So, is Andy Behrman an honest whistle-blower or a calculating opportunist? Has he been overtaken by his illness again? These are questions we might not ask if more thought, care, and scrutiny had gone into the communications planning and review process.

Good - Not Great - News on Pharma Reputation

Hold the Champagne for Now

You may have read of the recent Harris Interactive Reputation Study that showed that "the overall reputation of Corporate America has never been worse in the eyes of the general public." The bright spot in the report? Surprise! It's the pharmaceutical industry.

Pharmaceuticals posted their highest rating in five years -- up to 31% in 2008 from 26% in 2007. Is this the beginning of a turnaround? Is the public perceiving more value in the discoveries and treatments from this critical industry? Maybe, maybe not.

To place this in perspective, we can look at what else transpired in this time frame. With bank failures, AIG, home foreclosures, executive bonuses and Bernie Madoff, the financial services industry has fallen into the reputation cellar with the tobacco industry. Both share an 11% positive rating by the public. And, there's the auto industry. It suffered the largest decline (22%) in the survey's history. So, while there may indeed be some reason to cheer, the uptick for pharma may be a case of looking good by comparison. And, remember, 31% good means 69% not good.

I'll hold on to some hope, though. This increase in Harris' "Reputation Quotient" was observed during a time of high-profile drug withdrawals, the Presidential election (which included industry bashing from both sides) and the largest average price increase in five years. Something went right for the industry.

During this time, also, was a steep decline in DTC advertising -- a drop-off of 8% in 2008, which followed a 4% decline in 2007. Is less DTC advertising inversely proportional to pharma reputation? Or, is this pure coincidence? I wish I had some data to share -- this would be an interesting phenomenon to study.

What I can tell you is that I have a hunch that these facts do have an association. I've been saying for years that, while some efforts do a great job of informing and educating, DTC advertising can trivialize side effects, create false hope and interfere with an individual's calculus of risk/benefit. In addition, the pervasiveness of some ads has fueled the perception that increases in promotional spending come at the expense of research and development. Indeed, at the end of last year Roche CEO Bill Burns said, "DTC advertising has been the worst decision for the drug industry. When industry says we're spending all the money on R&D, but actually it's spending it on TV advertising to preserve margins, it doesn't get much credibility." And, more recently, concerns have been escalating over the appropriateness of some ads (e.g., ED spots during "family hour").

Here's a case where less really could mean more. Fewer shot-gun approaches to advertising and fewer goofy stunts in an attempt to start a discussion may lead us back to more effective communications that improve relationships with stakeholders and enhance industry reputation.

Swine Flu's Teachable Moment

An Opportunity for Public Health and Vaccine Manufacturers

It was disturbing to read about a growing public health threat in "Vaccine Refusal, Mandatory Immunization, and the Risks of Vaccine-Preventable Diseases" in this week's New England Journal of Medicine (Omer et al.). The bottom line is that there is a critical need for new education and policy efforts to protect children (sometimes from their own parents) and the general public.

Here's an example of some of the bad news: In the case of measles, it's been estimated that more than two million cases occurred each year in the U.S. before a vaccine was available. In a triumph of science and medicine, the number of cases dropped to a mean of 62 per year between 2000 and 2007. In the first four months of 2008, however, 64 cases were reported with 63 of those occurring in children who were not vaccinated. Why?

• Past success. With a number of diseases nearly wiped out by vaccines, it seems as though our memories have been wiped out as well. As time marches on, many have forgotten the potential severity of vaccine-preventable diseases. Using the measles example, some cases can cause pneumonia, seizures, meningitis or even death.


• Alternative medicine and junk science. Of course, "western medicine" does not have all the answers. But it's been reported that parents of unvaccinated children "were more likely than parents of vaccinated children both to have providers who offered complementary or alternative health care and to obtain information from the Internet and groups opposed to aspects of immunization."


• Ease of opting out. Although the constitutionality of mandatory immunizations has been upheld, individual states have the ability to set the bar and allow exemptions based on personal or religious beliefs. In another unfortunate example, "the mean annual incidence of pertussis was almost twice as high in states with administrative procedures that made it easy to obtain exemptions as in states that made it more difficult." It was reported also that children with exemptions were 35 times more likely to contract measles.


• Denial. Compared to parents of vaccinated children, significantly more parents of unvaccinated children believed their kids had a low susceptibility to diseases (58% vs. 15%) and that the severity of disease was low (51% vs. 18%).


• Lack of trust. Again, compared to parents of vaccinated children, significantly more parents of unvaccinated children believed that vaccine efficacy and safety were low (58% vs. 17%, 60% vs. 15%).

Although the hearts of parents who withhold vaccinations from their children for non-medical reasons might be in the right place, their brains are not. In the "rugged individualism" that many Americans use to define themselves, there is a consequence of putting others in harm's way. Those who are unvaccinated put their communities at a higher risk of disease outbreak.

Now, there's a race to develop another vaccine -- this one against the swine (H1N1) flu. Although no one wants a new disease to contend with, there may be a silver lining -- a chance to reengage the public on the importance of immunizations. No doubt there will be an educational push when the vaccine is available. But at the same time, a campaign should be tied-in to reverse the dangerous growth of vaccination exemptions.

No vaccine is risk-free and not every mind can be changed. Still, the CDC (with their reach and clout), vaccine manufacturers (who can gain sales and reputation) and health care providers (who are a trusted source and carry influence on family health care decisions) should join forces to develop a new dialogue with the public. And let's sustain the discussion, let's put the science and evidence in perspective, and let's build some trust.