Once more unto the DigiPharm breach.
Building up to reportable adverse events
When last we spoke, I covered patient community discussions. We now turn our attention to reportable adverse events and the Internet presented by Daniel Ghinn and Paul Grant. They start by re-stating the Nielsen report that suggested one in 500 adverse events were reportable, whereas Patientslikeme.com found that 7 in 500 were reportable within their own forums (Link to Pharma marketing Blog’s analysis). When Grant and Ghinn question attendees, a Boehringer employee mentioned that they had received three adverse event reports in the past 12 months and Sam Walmsley from Chandler Chicco PR agency found less than five associated with campaigns that she had worked on.
The presenters made it clear that content in context is very important in adverse event reporting. They hypothesise that in conversations, the volume of reportable adverse events are likely to vary by therapeutic area, channel and language. The duo picked a week in July and focused on 10 different therapy areas, looked at brand name variance and generic noise. They started with the brand, saw if a side effect was mentioned and then checked if personal pronouns were used (inferring a conversation). These filters created the conditions of possibility for identifying potentially reportable adverse events.
The results showed that spam, especially on Twitter, can make up a high percentage of results, and in fact, over 90% of product mentions in social media is spam in the US, 99% in Brazil and 93% in the UK, dropping to only 50% in France. From their analysis, by therapy area, potentially reportable adverse events range from 5% plus and if a brand or disease is in mainstream media, the incidence of potentially reportable adverse events spikes (the LiLo effect).
Ghinn and Grant point out that there are a large range of mentions of adverse events across therapy areas, so one-fit measurement is not a good idea and we also need to consider how many adverse event reports originate from counterfeit drugs or due to direct to consumer marketing. The point is made (in Twitter discussions) that many parameters to take into account analysing online data, so a global vision is essential to limit bias (@thibaudguymard) and that we should look to define and analyse adverse events from two angles: the formal regulatory one and the one as a nuisance to patients (@rohal).
Back on the stage, Ghinn and Grant show how a series of tweets could build up into a conversation that can exhibit all the requirements for a reportable adverse event (where individual tweets would not qualify), with a strong response from the floor. They ask questions in conclusion:
- Will you monitor real-time engagement?
- Will you take a global, national or regional view?
- How will you collaborate with colleagues across marketing, corporate communications and pharmacovigilance?
140 characters or less
next to the stage are Silja Chouquet and Andrew Spong with a rather unique silent presentation on Healthcare Social Media Europe (#hcsmeu). They demonstrate the power of the hashtag on twitter to provide a story. Rather than reproduce this, I’ll just point you towards the tweetstream between 3:51pm and 4:12pm (be warned that there is much joviality surrounding a certain risqué comment…).
HCPs do not like reps. At all.
The final event of the day is a panel discussion featuring Dr Ameet Bakhai, Consultant Cardiologist, Barnet General Hospital, UK on reaching key decision makers – the challenges. The panel discuss iPhone apps for measurement and assistance of patient care. They say that, even within the British National Health Service (which is thought to be old-fashioned technically), physicians are very tech-savvy and mention that the top-selling iPhone app for physicians is a stethoscope (although I could find data to corroborate this). A word of caution from the panel: social media can be a quick and efficient way of killing people, but Pharma cannot live ‘in backward days‘.
A question from the floor: What’s the future of the pharmaceutical representative? The answer: The rep is only useful as a local conduit, as HCPs can find connection quicker than rep. In fact, some UK practises have banned sales reps, who will have no access to physicians in those clinics. One panel member opines that if a sales representative does not send the presentation in advance, they will not be seen. If they do send one in advance and it does not interest the HCP, they will not be seen. Dr Bakhai says that there is no need for Pharma reps, unless they are knowledgable, add value and are working with med/marketing colleagues. My guess is that he is really focusing on the value of field-based Scientific Advisors (Some companies call these Medical Speciality Managers [MSMs] or Scientific Managers [SMs]), who focus more energy on the data rather than relying on sales aids that use a specific story flow. Additionally, we need to consider that this is the opinion of a small panel and may not necessarily reflect the views of the thousands of HCPs in the UK.
When asked if the panel have an example of where digital-pharma oriented companies can work with HCPs to benefit the patient? Dr Bakhai responds that a Pharma company has helped build a website & provide a telemonitoring resource for cardiology patients in the UK. In the future, Pharma need to help physicians use technology effectively, such as help develop ECG on mobile phones. He also likes accredited CME he can use on a smartphone and share with his expert patient panel (he demonstrates an app to teach CPR). My position – this is hard in Europe right now, fragmentation of differing national CME/CPD systems and requirements notwithstanding, EACCME are evolving and in flux with respect to how to proceed with CME, and currently (unless you are a UK physician, as the Royal College of Physicians allows sponsored CPD events) there needs to be a hands-off approach (you can’t use your promotional medical education agency for CME activities in Europe).
Another question to the panel: have you ever been to any Pharma sites to find drug information? The answer is a simple no, but they do use Wikipedia as a point of care decision-making resource. The problem may be that Pharma is very slow to approve and update content – it means that these sites are much less relevant and behind and disengages ‘customers’. Parting shots to Pharma: ‘spend time in the front line. Spend one day in the field. You (Pharma), we (HCPs) and patients will all get something out of it‘.
Thanks for your time, that concludes today’s post and Day 1 of DigiPharm Europe 2010. I’m planning to cover Day 2 in two posts, so you’ll be pleased to know I’ll be finished on Friday!