Mixing Social Media and Health Care: Concocting a Worst Case Scenario Using Big Pharma and Manipulated Web 2.0 Writers

Are there any downsides to the mixing of social media and health care? An interesting "Perspective" article by Boston academicians Jeremy Greene and Aaron Kesselheim in the latest New England Journal (not online yet, but check back for the link) says "yes" by taking the worst of both worlds: misinformed and manipulated Web 2.0 writers on one side and the misbehaving pharmaceutical industry on the other.

They point out that the pharmaceutical industry's marketing has generally been under very tight control by the Food and Drug Administration (FDA). Ironically, however, it was the FDA's guidelines surrounding direct to consumer (DTC) advertising that ultimately unleashed the glut of dry eye, erectile dysfunction and when diet 'n exercise-are-not-enough high cholesterol TV commercials. Well, following a November 2009 hearing on the matter, the FDA is now gearing up to issue guidance on the use of social media in pharmaceutical advertising. Once that happens, we can expect a considerable portion of the pharmaceutical industry's annual $4 billion budget to be spent on product-promoting bloggery, tweets and friending.

Which worries Drs. Greene and Kesselheim. They fear that authors of blogs, Facebook accounts and Twitter feeds that have only nice things to say about drugs or their manufacturers may be paid, biased, not credible or have hidden conflicts of interest. To deal with this, the authors suggest holding both the pharmaceutical industry and the FDA "responsible" for any significant misinformation and raise the possibility of creating a Web 2.0 FDA "seal of approval" to promote accurate content.

While worst case scenarios can be instructive, the DMCB isn't convinced that even the pharmaceutical industry's billions are up to the task of bending a truly massive and hyper-distributed social media global network to their will. What's more, pharma's tarnished reputation has already attracted the attention of legions of simultaneously smart and hostile bloggers, who seem more than ready to counter any product claims - including the credible ones. Last but not least, the DMCB is coming to doubt any laughably "responsible" Federal agency's ability to do anything quickly, cheaply or effectively. Better to let the bloggers establish their own reputations for transparency and pursue their own seals of journalistic/scientific excellence, perhaps through resources like this.

Last but not least, the DMCB is a believer in open and democratic discourse. Trying to influence the free flow of information, even if the filters are contrived by well-meaning do-gooders in some windowless room at the FDA, just seems to have too many downsides. If anything, the FDA should be working to promote an independent, skeptical and vibrant Web 2.0 scientific community. After that, they should get out of their way.

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The Backlash Against Pharma and The Role of Disease Management

Readers may recall that several physician-leaders have recently authored an article in JAMA recommending that all professional medical associations gradually reduce pharmaceutical and device support funding - except meeting hall exhibits and journal advertising – to zero.

From time to time in the near and distant past, The Disease Management Care Blog has done business with the pharmaceutical industry. It has found the exchange to be honorable for both parties. On the other hand, while serving on Pharmacy and Therapeutics Committees and while in clinical practice, it has witnessed some troubling marketing activities. The DMCB has no easy answers on what the relationship between medicine and pharma should be, but thinks the proposed funding ban described in JAMA won’t be the final word on the matter. It thinks there’s a backlash underway. Once passions cool, a new equilibrium should emerge.

In the meantime, the DMCB was unsurprised that the proposal described above exempts the medical journals. That’s because physicians ‘can easily distinguish these marketing activities from education presentations and are free to ignore them.’ In other words, leafing through the drug ads to get to the JAMA opinion piece should have little impact on the reader.

The DMCB appreciates the irony and sympathizes with the journals’ wish to reduce their readers’ subscription costs with advertising income. On the other hand, it doubts the sponsors of these ads agree that they have little impact on the very readers that the physician-leaders are working so hard to protect from the pharmaceutical and device industry. While it could be argued that the ad content is regulated, the agency charged with that oversight has a spotty tract record. What’s more, there is evidence that journal ads that pass regulatory muster still fall short.

So the DMCB has a suggestion of its own. Since journal editors know how to edit, perhaps they should apply their skill set to developing a higher standard of truth in print advertising that they accept – such as the prominent display of vetted ‘number needed to treat’ data. Alternatively, they could also consider getting in line and falling on the sword as the professional medical organizations.

The DMCB doubts either will happen. In the meantime, the disease management organizations and Pharmacy Benefit Managers have a continuing role to play in objective, ethical and conflict-free coaching of patients and providers about the risks, benefits and alternatives to the use of medications and devices. Given all the atmospherics, however, perhaps it’s time for the industry to think about developing its own set of standards that are reasonable and free of backlash politics. Given its pedigree, the DMCB thinks it could develop a more balanced approach that could help the rest of health care out of this morass.