Tweet, Tweet, Tweet: Pharma Finding Its Niche?

The industry has been slow to adopt new technologies in the highly regulated pharma world, but both big and small biopharmas alike are beginning to find their comfort zone with limited-character media like Twitter.

Twitter and other areas of social media have long-since become a staple in most people’s lives, but due to tight regulatory controls and the serious nature of health care, biopharma companies are still hammering out how best to interact with stakeholders in these less traditional mediums.

Some companies have jumped straight into the fray in a big way (Novartis AG recently even started an Instagram account), while others are proceeding with great caution.

A look at the Twitter accounts of major pharma players is evidence enough that the industry is making an effort to use the tool that its patients are using, but those same Twitter accounts also show just how uncomfortable the industry is with the medium. Eye on FDA, an industry blog that tracks Twitter trends for pharma and medical device companies, has found 264 Twitter feeds that represent the industry. Of those accounts, only 49 companies are represented and only 79 handles are active on a regular basis. All but two of the top 25 firms by market cap participate, however – the exceptions being Shire PLC and Valeant Pharmaceuticals International Inc.

“The stance that pharmaceutical companies are taking is conservative. That being said, Twitter can still be an important part of the social media activities of companies, even if it needs to be more around disease management, patient awareness or directing people to channels where they can find more information,” Murray Aitken, executive director of the IMS Institute for Healthcare Informatics, said in an interview.

While the industry as a whole has shown trepidation toward social media, some companies are embracing it. In April, Acorda Therapeutics Inc. launched its second Twitter account, @roncohenshair. The account began as a private joke between the company and ISI Group analyst Mark Schoenebaum, but has gained traction quickly.

“Mark Schoenebaum, for whatever reason, has an untoward fascination with my hair,” joked Acorda CEO Ron Cohen, who is one of the people behind the account. “We hit upon a wonderful way to use social media that would be fun and drive traffic to the Acorda site and we use a lot of important hair grooming tips to comment on current events. It’s a terrific way for us to have some fun, but also with the serious intent of getting interest in the things that we’re interested in.”

It’s not something that Acorda entered into lightly, despite the satiric nature of the account; the company’s approach to social media has evolved much like that of the industry’s approach overall.

“When we started @AcordaNews, we had to beat our legal team over the head to let us do that and all it was doing was pushing out press releases,” said Jeff Macdonald, Acorda’s senior director of corporate communications and one of the masterminds behind @roncohenshair. “[It became easier] as our regulatory and legal colleagues got more comfortable with the medium and as Twitter got a staying power, it is being used more in the way it was intended to be used and that’s to create discussion and dialogue.”

Macdonald and Cohen admit that both the companies’ accounts began to gain more followers and get more feedback from users when the content stopped focusing on Acorda news items and began getting into some of the issues surrounding the industry or that are important to patient advocacy groups.

“People are more comfortable with technology now. People are more comfortable with how Twitter works. Our industry is not known for being an early adopter. This is no different than other areas where pharma has been a little bit late in coming to the party,” Macdonald said. “It started it out with a lack of understanding of where the platform was going, but once we got more comfortable with it we started to see the guardrail expand.”

Twitter already has become a well-entrenched tool for many other industries that use the social media site as a means of advertising products and reaching out to customers. The limited-character site has also become a news tool for the media, which uses the site to gather and disseminate news – often breaking stories before traditional news outlets (see box to follow “The Pink Sheet” on Twitter).

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A Multi-Faceted Approach

A company’s comfort level with Twitter is easily viewed – take a look at the number of tweets a company has posted since the account was created (both stats can be found on a Twitter bio page or the infographic in this article) and it’s easy to see just how active the account has been over its lifetime.

Mark Senak, the author of Eye on FDA and a partner at the public relations firm Fleishman Hillard, notes that many pharmaceutical companies created their Twitter handles when the service first was started several years ago, but have since stopped using them or created other handles that they use more frequently.

“A lot of accounts are abandoned properties, they aren’t updating on a daily basis” said Senak. “Abandonment may be reflective of a lack of a cohesive internal policy for social media at a company. Often [with] companies that have offices all over the world, someone will start something up and then leave it.”

Abandonment of an account doesn’t necessarily mean that a company has gotten out of the Twitter game altogether; most companies have several Twitter handles. Eli Lilly & Co. has seven in the U.S. alone. Why so many? Each Twitter handle is geared toward a different audience; for most, that means different geographies. Pfizer Inc. has accounts representing more than 10 countries, but others are used for disease awareness or even employee recruitment.

Accounts in different geographies let companies reach customers that might be affected by different interests or overseen by different health care governing bodies; adding a hashtag like “#USOnly” can help companies comply with requirements to restrict information to certain audiences, similar to how press releases are issued or conference displays identified for U.S. or international participants.

“Different companies have different approaches with respect with what they are trying to achieve and how they are trying to reach patients. That’s reflected in the way they set up their social media activity. We don’t know what’s best practice or what’s the best way to do things because this is still an emerging space,” said Aitken.

Recruitment has become one of the primary uses of Twitter for pharma and biotech companies. Most of these handles have the word “careers” in them or some indicator that the feed likely will include job postings.

“Recruitment is one of the primary goals of our Twitter account,” said Trista Morrison, the voice behind Ironwood Pharmaceuticals Inc.’s account and the company’s director of corporate communications. “If you look at the tweets we are posting about being patient-centric and our community involvement, I think a lot of the reason we put that out there is so that people who are considering coming to work for us know what sort of company we are. We want them to see what is important to us.”

Attracting talent is far from the only way companies are making Twitter part of their communications strategy. Disease awareness is one of the biggest focuses of pharma on Twitter. Some companies have disease-specific handles like @LillyOncology and Johnson & Johnson’s @Psoriasis360, while most are using their main feeds to further the conversation in areas where they work.

“The primary focus of LillyPad has been public policy and general health awareness,” said Amy O’Connor, senior director of Lilly’s digital and social media. She notes that her team of four are attending and tweeting from “a lot of advocacy-related conferences.”

Twitter use at conferences has been on the rise the last few years as the service becomes more popular; what once was a fringe activity mostly used by early adopters is now mainstream. Companies are getting in on the act by using the events as a means to connect with their stakeholders. A look at the recent Biotechnology Industry Organization conference in late June in San Diego shows that Twitter use has jumped dramatically – with the number of mentions of the event hashtag (#BIO2014 vs. #BIO2013) increasing 122.5% over last year (Also see "BIO 2014 Thursday Round-Up: Deal-Making Versus Internal Innovation" - Pink Sheet, 26 Jun, 2014.).

More than 4,050 different handles used the #BIO2014 hashtag during the event, which saw about 15,000 people in attendance. @LillyPad was the most active tweeter, with two of Lilly’s other accounts – @Modernmeds and @PaceNetworkUSA – making the list of the top 10 BIO tweeters as well (Also see "BIO 2014 Wednesday Round-Up: The Search For Innovation" - Pink Sheet, 26 Jun, 2014.).

Similar results have been seen at other conferences – the number of tweets using the event hashtag at the American Society of Hematology meeting more than doubled from 2012 to 2013, and the use of the #ASCO hashtag jumped from 9,366 mentions in 2011 to 19,973 mentions in 2013, according to press reports.

“Twitter has become part of the communications plumbing. It is no longer an add-on,” said Senak. “A lot of companies have come to embrace this and acknowledge that Twitter is now part of the communication infrastructure. You have to look no further than a medical meeting and the Twitter traffic at a medical meeting. You have to understand that everyone going to those meetings – doctors, researchers, journalists, companies – and they are all talking about what is going on at an increasing rate.”

Product Pushback

While the lightweight brevity of Twitter’s character space limitations has made it an ideal platform for medical meeting attendees to express quick facts or a point of view, the 140-character medium has not turned out to be the ideal format for companies to push their products.

In fact, most companies have shied away from discussing products at all in the forum, partly out of concern about the promotional requirements for disclosure of risk information. O’Connor admits that products are not a focus of Lilly’s social media strategy when it comes to Twitter. Morrison says Ironwood takes a similar stance; the biotech uses “buckets” of topics that it considers suitable for Twitter to assess what to tweet about.

“When we decided that we wanted to explore having a Twitter presence we made a concerted effort to sit down with all the various departments within the company and we talked about how we wanted to approach Twitter. It’s something you have to be a little dynamic about – you are always having discussions about it,” Morrison explained.

More recent discussions within Ironwood, and just about every pharma company with a Twitter account, have centered on FDA’s recent issuance of a draft guidance for the medium. The guidance on “Internet/Social Media Platforms with Character Space Limitations – Presenting Risk and Benefit Information for Prescription Drugs and Medical Devices” was released in June along with others that gave parameters on how to correct third-parties on the internet.

The regulatory agency’s guidelines for promoting a product via Twitter require companies to include the product name, indication and its most pressing risks, as well as a link to a full explanation of all of its risks (Also see "FDA’s Twitter Formula Allows Tweets About Products Without Excessive Risks" - Pink Sheet, 17 Jun, 2014.).

“That leaves no room in the tweet; what that reduces it to is an advert. It has no news,” said Senak. “[The draft guidance] turns on lights for what FDA’s requirements are and what they would expect to see, but it doesn’t illuminate the pathway for you to actually be a participant in Twitter in a product-centric way because it’s not an advert. That’s not the primary use of the platform.”

Senak’s opinion has been echoed widely; most industry commentary has noted since the guidance was unveiled that Twitter likely never will be a place for product promotion (Also see "Social Media Marketing: FDA’s Old-Time Approach May Turn Industry Away" - Pink Sheet, 23 Jun, 2014.).

“Twitter presents its own unique challenges with respect to the limited amount of information that can be presented in 140 characters. FDA has made clear through its guidance that it’s not going to be realistic for companies to use Twitter with respect to certain medicines given the requirement that certain side effects and risks need to be listed in any given communication,” added Aitken.

Despite FDA’s limits for character-limited communications, some companies are making a go of it. Novartis has a product-centric handle, @GILENYAGoUSOnly, geared toward the multiple sclerosis community in promotion of its medicine Gilenya (fingolimod), which has more than 8,000 followers and has tweeted about 260 times (Also see "Biogen Idec Undercuts Gilenya With $55,000 Yearly Price For Tecfidera" - Pink Sheet, 1 Apr, 2013.). Biogen Inc. is also experimenting with product promotion on Twitter with the recent launch of its account @ELOCTATE, which is meant to educate about its hemophilia A treatment of the same name (Also see "Hemophilia Market Snapshot: Is There Enough Innovation For Patients To Switch?" - Pink Sheet, 30 Jun, 2014.). The drug was just launched in July and the account tweeted about 20 times in its first month.

Measuring The Intangible

With product promotion posing a somewhat precarious proposition, it’s important for companies to know why they are participating in social media and how best to measure that return on investment. Taking a look at followers and the number of tweets can be a good indication of how active an account is, but without a close look at exactly who those followers are, it’s hard to tell if the account is reaching the right people.

Lilly @ BIO

@LillyPad said, “Collaboration helps bring new medicines to the people who need them, faster. http://ow.ly/ysEsG  #BIO2014”

And earlier on June 26 @LillyPad wrote, “’I think we should celebrate innovation. Innovation is the way out of our problems.’ - @WIPO Director General Gurry #BIO2014”

“Value of continuous innovation cannot be ignored when studying a new medicine: http://ow.ly/yuUsJ  #BIO2014” said @PaceNetworkUSA on June 28

@Modernmeds wrote,” Collaboration amongst patients, researchers, physicians is key to #raredisease progress http://ow.ly/yshQa  #BIO2014” and later tweeted about the NIH/industry collaboration, saying, “AMP up collaboration to bring medicines to patients faster, says @NIHdirector: http://ow.ly/ytYrr  #BIO2014”

“For us, it’s not how many people follow you or how many tweets you have, but who you are talking with,” O’Connor said of measuring the success of Lilly’s Twitter presence. The company’s main account, @LillyPad, had more than 79,300 followers and had produced almost 10,000 tweets as of mid-July. “When the right people are getting the right message, we know it’s working. While we monitor the regular analytics, we also have thought-leaders reaching out to us and sharing our tweets. People are finding our tweets valuable and sharing them with others.”

The number of retweets, favorites and how many clicks a link in a tweet gets are some measurements that companies can use to track what sort of reception they are getting on Twitter. A report produced by IMS Healthcare Informatics in January looked at pharma impact in social media, and noted that companies can be producing great content, but without reach and relevance they will not be building significant relationships.

“It helps you get your message out, but it also helps you better understand what is important to people. It gives you a better understanding of what messages are resonating with people,” said Ironwood’s Morrison, who tracks the retweets, favorites and link click-through rates for the company’s account.

In its report, IMS tried to rate companies based on their reach in social media, including Twitter, Facebook and YouTube. Johnson & Johnson, GlaxoSmithKline PLC and Novo Nordisk AS rounded out the top three companies on IMS’ Social Media Engagement Index due to their engagement with the three media channels. Aitken notes that the data firm only looked at accounts that dealt exclusively with health care content, and not accounts that were geared toward investor relations or recruitment.

Johnson & Johnson is particularly active on Twitter – the company has more than a dozen Twitter accounts, including its @JNJNews, which has more than 67,000 followers, and @JNJCares, with almost 34,000 followers.

“Our industry in general struggles with how best to employ social media, in large part, because we are so highly regulated,” Acorda’s Cohen reflected. “It is very natural, and highly justified, conservatism when it comes to social media because there is a desire not to be exposed or to be vulnerable to regulatory blowback. We are still learning. I expect that we will continue learning and our goal is to be an integral part of the lives of the patients we serve as a company.”