Social Media and Drug Advertising: Information and Warnings for Physicians and Patients
The Internet has rapidly developed, with users moving from passive information using read-only “Web 1.0” technology to interactive, tailored relationships using “Web 2.0” technology. This includes social networking sites and other interactive systems that have created new direct-to-consumer advertising (DTCA) marketing opportunities that transcend geopolitical borders. Currently, the FDA has not issued guidelines on this type of drug marketing. However, drug advertising using the Internet may have a presence already. Physicians should counsel their patients on the challenges of social media drug advertising.
Social Media Marketing: Pharmaceutical Companies
There are several means by which social media marketing may occur. Pharmaceutical companies may, of course, develop corporate webpages that market products or provide health information directly to the public. However, with Web 2.0 technology, these webpages may also serve as launch points for access to the entire panoply of social media platforms.
The spectrum of social networking tools used by drug companies is as broad as those available, including Facebook pages, Twitter accounts, blogs or RSS feeds, dedicated YouTube channels, and iTunes store applications sponsored by drug companies. These are accessible globally.
Furthermore, these social media efforts can incorporate DTCA promotion strategies, including patient testimonials and product information, as well as extend their influence through hosting of direct-to-consumer media online and linking to favorable research data. The potential reach of social media marketing is enormous, allowing for interactive marketing to millions of potential consumers globally.
Some of these social media efforts may be presented as “neutral” information, despite being corporate-sponsored. This is particularly true when it employs third parties, e.g., bloggers, “consumer opinion leaders,” or other paid individuals/companies to promote products without disclosure; moderated forums/sites that appear interactive but only offer one-sided communication; and “unbranded websites” without sponsorship disclosure.
Social Media Marketing: Illicit Sales
There is also a nefarious parallel set of social media marketers selling drugs. The Internet is rife with rogue online pharmacies using marketing tools as their primary vehicle. These illicit drug sellers, for example, have used sponsored links and search engine shopping pages before they were stopped. Now they have transitioned to Facebook and Twitter, with direct links to sites that will sell purported drugs without a prescription. In fact, some of these sites are impossible to differentiate from the actual manufacturer’s. Social media marketing has emerged as an unregulated marketing tool for legitimate and illicit sources alike, and consumers lack insight on whether such information is valid or not.
Implications
Because more than half of U.S. adults and hundreds of millions worldwide use the Internet for health information, it is unsurprising companies have moved into this area for marketing using eDTCA2.0 tools, spending an estimated $1 billion. What this means, on one level, is that social media marketing of drugs directly to patients may not be limited to the United States or New Zealand.
Social media marketing has globalized DTCA to anyone, anywhere with Internet access. Rapid social media development may place the FDA even further behind in attempting to regulate both DTCA and illegal online sales, while global DTCA prohibitions are being emasculated.
Patient safety may also be compromised. Drug advertisements show suspect quality with the overemphasis of benefits, so patients may not adequately assess risk. Furthermore, marketing focus on high volume and/or chronic disease drugs may place vulnerable patients at risk, perhaps disproportionately, because blockbuster drugs are most heavily marketed early in product lifecycles when safety profiles are incomplete. Heavily promoted DTCA drugs have, in fact, been associated with safety advisories and Blackbox warnings. U.S. safety concerns may become global health concerns under eDTCA2.0.
Patient safety is also clearly undermined by illegal online pharmacy social media use. The clear risk is that patients may be purchasing drugs without professional oversight, that are unapproved, and/or those with safety concerns, assuming authentic drugs. But online pharmacies have also been found to sell counterfeits and tainted drugs, resulting in patient death and injury. These rogue sellers have been extremely nimble, and it is no surprise they have adapted to Web 2.0 technology. This magnifies the importance of public health regulatory body warnings about purchasing drugs online and obtaining information from trusted sources.
Social media marketing use by companies and illicit online pharmacies may inappropriately increase demand and compound harm by permitting self-prescribing and direct, illegal purchase. And because search engines drive consumers to content, interactive social media may receive higher traffic due to repeat use or other website links. It will appear higher in search results with concomitant higher impact, allowing it to become a dominant source of health information, potentially displacing healthcare professionals.
Physicians and Patients
It is critical for physicians and patients to be well versed in Internet drug sales, their risks, and their benefits. Patient safety must be paramount. Not only have traditional pharmaceutical manufacturers entered into the social media marketing arena, but also drug sellers acting illegally online. Several areas bear emphasizing for physicians and patients:
- Physicians and patients should heed the warnings from the FDA and other international regulatory and public health bodies and strongly warn and guard against drug purchasing online. Only purchase from National Association of Boards of Pharmacy Verified Internet Pharmacy Practice Sites (www.nabp.net/programs/accreditation/vipps/find-a-vipps-online-pharmacy).
- Physicians should counsel their patients as to the risks of online drug purchasing and other nontraditional sites of drug access. In particular, social media and other interactive sources of information should be viewed with suspicion.
- Physicians should counsel patients to use only trusted sources of information online. Avoid any nonofficial sites, and rely only on trusted specialty or other formal information source not selling products.
- Physicians should counsel patients to know what drugs they are taking, and know their options for obtaining them safely. Using checklists such as the SAFE DRUG checklist, keeping a medication diary with patient impressions and reactions to each drug, and having information on low cost/no cost drug programs can assist patients to be partners in medication safety (available at safemedicines.org).
Overall, social media marketing of drugs represents a significant challenge. The evolution in these and future forms of pharmaceutical marketing will not wait for regulation. Both licit and illicit industry will continue to innovate and move forward in a rapidly changing Internet environment. Physicians must be knowledgeable about these risks so as to best advocate for patients and patient safety.