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The necessity of clinical trials as a means of assessing potentially life-saving interventions is widely accepted by healthcare providers and medical researchers alike.  Also generally agreed upon is the difficulty of finding patients who meet the necessary inclusion criteria to participate in these clinical trials. In part, this challenge can be attributed to the administrative burden of having to match potential patients to specific selection criteria. Additionally, the traditional patient pool is further limited by geographical proximity to the clinic or laboratory where the trial takes place. I asked my colleague and the CEO of Prime Access, Chip Weinstein, for his thoughts on what could be done to help recruitment. Here is Chip’s response:

“Brian Clark’s TrialMatch hack, revealed at the TechCrunch Disrupt SF Hackathon, seeks to jump the administrative hurdle by extracting the inclusion and exclusion criteria from existing studies posted on ClinicalTrials.gov, and matching those criteria to the user profiles of potential clinical patients.  Meanwhile, Apple’s new open source platform, ResearchKit, aims to circumvent the physical distance barrier between patient and research facility by using the already standard iPhone features to measure and record patient data. ResearchKit’s launch introduced five new apps to the platform, each of which focuses on a different health issue. Within days of the initial launch, the studies drew thousands of new participants, who were able to use their phones to take basic physical tests without traveling to a laboratory.

“While both of these platforms are certainly steps in the right direction, neither TechCrunch nor ResearchKit quite answer the question of how to persuade people to sign up in the first place, nor do they address the full range of barriers preventing willing volunteers from participating in clinical trials. By relying solely on medical records and clinical inclusion and exclusion criteria, both Apple and Clark are overlooking a major determinant of health behaviors: cultural identity.

“According to the 2010 U.S. Census, the population of Hispanic Americans increased by 43% and now comprises 16% of the U.S. population; African Americans make up 12.6% of the total U.S. population, and the Asians American population increased by 43.3%, and now comprises 4.8% of the U.S. population. There is no Census data on LGBT individuals, but the Williams Institute estimates that 3.5% of the U.S. population identifies as LGBT. These are not insignificant numbers in a population of approximately 320 million, yet minority groups consistently report lower satisfaction with their medical care, and have lower health outcomes than their Caucasian counterparts. Numerous studies have attributed these disparities in access to and use of health services to socioeconomic factors and health insurance coverage.  While these are certainly material observations, it is also important to give weight to the pertinent cultural factors.

“We at Prime Access understand that a discussion about health cannot be separated from its cultural context, which is why we utilize a Total Market approach to reach a demographically diverse audience. As of 2014, the Selig Center reports that the Hispanic market holds the highest minority group buying power, at $1.3 trillion, with the African American market not far behind at $1.1 trillion. Asian American buying power is expected to reach $1 trillion by 2019, and Witeck Communications estimates the current buying power of LGBT identifying individuals at $884 billion. To maximize revenue-generating potential in a complex and multicultural world, it is imperative to understand the unique identities and interests of target consumers.

“It is equally important to recognize that while cultural groups do have shared experiences, they each have their own singular needs. For example, Hispanic and LGBT patient groups both face obstacles when accessing healthcare. However, whereas for Hispanic patients these barriers appear rooted in a lack of understanding of their cultural needs, LGBT patients are more likely to experience institutional stigma in response to their identity. Consequently, the lack of access to health services manifests in different health outcomes for each group: Hispanic patients tend to suffer more from cardiovascular disease, diabetes, and asthma, whereas LGBT patients tend to have a higher prevalence of depression, anxiety, suicidal ideation, eating disorders, and substance abuse. Therefore, marketers must employ different approaches to engage each group and meet its specific needs.

“To that end, mobile phones provide an accessible and versatile vehicle which can be used to reach multiple demographic groups simultaneously. According to a Pew Research Center, 90% of American adults own a cell phone, and 63% of adult mobile phone owners use their phone to access the Internet, which makes cell phones the perfect platform for the development of a patient-friendly mobile app or service.  Moreover, separate apps can be developed to target different groups with demographic-specific material, and thus capture potential clinical trial patients in studies most relevant to their needs.

“In a diverse and increasingly industrialized global community, it would be wise to allocate resources to advancing technology that can be used to target specific patient needs. Because health care decisions are so deeply entwined with cultural identity, it is necessary to address every facet of prospective consumers when seeking to engage their participation. Through Total Market strategy, marketers will be able to understand and provide for the specific needs of a wider, more diverse audience.”

It’s probably safe to say that you’ve been to the doctor at least once in your adult life. So you can probably relate to this:

You’re sitting on the exam room table in your physician’s office.  In your head, there’s a lengthy list of questions related to the reason for your visit – an aching back, perhaps, or persistent heartburn, maybe a minor sprain – and you’re hoping you don’t forget any of them. Your doctor walks into the exam room after what feels like an eternity, even though it’s probably only been 10 minutes, and asks, “How are you today?”

“I’m fine,” you answer.

You’re not alone! Doctors say this is a common scenario … and one that makes effectively treating patients all the more challenging.  “I’m fine” has become a default response.

One of the most important interactions individuals can have is about their health. But empowering patients, educating them to take control of their health – avoiding the default “I’m fine” answer – is one of the greatest challenges DTC marketers face. In fact, it’s one of the greatest communication challenges in healthcare, period.

It’s also one of the greatest opportunities. So how can you overcome that challenge? Where do you start?

In my opinion, the most effective way to overcome communication challenges starts in the exam room. And it’s so critical to the patient, the physician and the pharmaceutical marketer to get that interaction right.

I call it the “magic moment.” It’s that moment in the scenario I described above, right before the doctor comes in. You’re sitting on the crinkly-paper exam room table (with your phone put away!). You look up and see a display of approachable, aspirational brochures. Or maybe it’s a mounted digital device that invites you to learn more about your symptoms with a few taps of your fingertips. The privacy of the exam room is a safety net where you can learn more about the reason for your visit, arm yourself with questions for your doctor and feel empowered to discuss your diagnosis after engaging with meaningful, condition-specific education.

What constitutes meaningful education? Easy-to-understand, for starters. Eighty-seven percent of U.S. adults read at an intermediate level or lower, so materials are most effective when written in what health literacy experts call “plain language” – a fifth-grade reading level, at most.[1] It’s easy for us as marketers to lose sight of this and go for the more complex messaging, but if patients can’t understand what we are saying, they won’t be empowered to ask the right questions.

Then there’s the medium itself, which can also make patient education more meaningful: interactive touchscreen technology, engaging videos and, yes, even print – each medium is particularly effective for certain patient demographics.  All serve as an opportunity to appeal to a patient’s learning preference and to provide a guide to a patient’s condition.

But content is also key. The most meaningful exam room education addresses not just the condition, but the underlying causes, lifestyle management and treatments as well. Treatment options will obviously vary depending on the condition and the progression of the disease state – so education must help patients learn how to communicate with their doctors throughout their diagnosis and journey.

This approach works. According to PatientPoint results, 9 out of 10 patients learned a tip they could take action on from our exam room education, while 96% of patients agreed we make health information easy to understand.[2] This translates into 5 to 1 ROI and 11% NRx average lift.[3]

So the next time you’re in your doctor’s office, sitting on that crinkly-paper exam room table, take a look around. Look for information that’s meaningful and draws you in. If you’re seeing one of the healthcare providers that such provides such resources, it’ll be there, ready to empower you to take control of YOUR health.

References

[1] Static Brain, “Illiteracy Statistics.” 2014.

[2] PatientPoint national survey. 2015.

[3] Symphony Health Solutions. 2015.

Managing social media in the healthcare space can be challenging and must be approached with a unique strategy by brands.  In my experience, a brand’s objectives for organic social media can run the gamut from listening and research, to marketing and engagement, to sales and CRM.  (Not all at once, thankfully.) I'm focused on achieving success in the organic space, and leveraging insights to optimize a brand's paid social spend. However, in my research on the health industry, it often seems that companies eschew interaction on social platforms, with their best case scenario avoiding any kind of pique or penalty. As such, too many paid social efforts appear unfitted based on the audience they are serving.

Somewhat inevitably, this approach leads to a disregard for several social media fundamentals – authenticity, balance, connectivity – a scheme not ideal for controlling the message. To be fair, it’s a not a universal failing, for I did come across some modestly successful provider-as-lifestyle-partner posts, and message boards with brand-as-facilitating-host.  My first impulse was to diagnose a vicious cycle where lack of resources or talent led to a subsequent deficit in results, which in turn ensured a steadfast lack of commitment, and caused the under-investment in resources.

Learning the primary root of social media anxiety in pharma

I read industry blog after industry blog, which led me to the FDA’s Guidance for Industry documents. It is clear those drafts are daunting. During a recent poll conducted at an industry event, 95% of respondents cited compliance as the root of their reluctance to participate in social media.  It was not a lack of resources, nor talent, and not a difficulty in measuring ROI.

Understanding the FDA and compliance

Knowing the reason why most companies are reluctant to add paid social as a channel, I decided to read every line and footnote in each draft guidance from May 2009 to June 2014. I read every warning letter or notice of violation stemming from digital media over the past six years. I studied the FD&C Act and the Electronic Code of Federal Regulations.  I evaluated the advertising policies for each major social platform, even though I’m not a media buyer. I absorbed Mark Senak’s white paper, FDA Communications Oversight in a Digital Era, too.  Finally, I called the FDA.

My own point of view is that exposure to warning letters, notices of violation, or adverse events occasioned by social marketing, is evidently overstated. By my calculation, since 2009, the Office of Prescription Drug Promotion at the FDA have issued only three WLs/NOVs specific to social media.  As for the reporting of adverse events, I won’t make the mistake of downplaying their function. But I will say that of the sample studies I’m aware of, on average only 3% of posts include each of the four elements required for their reporting.  That’s a low number, whichever way it’s spun. I did not discuss my views with the FDA, and the FDA was not able to answer all of my questions. However, I emerged from that conversation with clarity.

We talked about social media platforms with character space limitations (Facebook ads are character-limited).  I also asked about reminder advertisements and reminder-like ads (which you should read more about, from the Food & Drug Law Institute’s Advertising & Promotion Conference, in October 2014).

What’s the risk?

The central tenet of my theory after the research, is that there is risk associated with any communication, but the notion that social media is some kind of unnavigable domain doesn’t stand up to scrutiny.  The legal and regulatory culture is different at every organization and remaining in compliance is no easy task.  Yet when a majority of violations are for omitting (or minimizing) risk, or because of unsubstantiated claims, one wonders how the content found its way out the door?  It is possible that small firms will take more chances, but when bigger players are using self-denial as a form of discipline, neither strategy provides the means to achieve meaningful ROI from social.

The solution with social media has to be audience-first. 

There are powerful listening and analytics tools that reveal a target audience: who the audience is, what the audience wants, when they want that, and how often to deliver it.  This information forms the bones of a basic social strategy which is allied to an objective. Regardless of whether it’s Pharma/Rx, OTC, or HCP, the underlying objective is conversion. Successful conversion is best achieved by understanding the organic audience, which in turn improves paid-social creative, targeting, and performance.

For this to work at scale, I’d recommend becoming familiar with the June 2014 Guidance for Industry , the forthcoming use of links to third party sites, and understanding how a reminder or a reminder-like ad can be customized and tested, be creative but not careless.

In terms of the big picture conversation; if other industries are deploying custom contact strategies, why isn’t health?  The most enduring social relationships originate from empowering exchange.