Social Media Networking: A Glitch in the Medical Matrix?

At one time, the Internet was a novel tool accessible to a privileged few. The rest of us, the excluded majority, had no way of conceptualizing that it would ever exist as it does today. Internet use spread rapidly, but programmers controlled most of the content in those early years of the information age. As landlines were pushed aside for wireless and local area networks became wide area networks, the world shrank. The speed with which information was transmitted gave rise to a need to remain connected to everything and everyone. The way we conducted business changed, users were given more control of their virtual identities, and social networking was permanently transformed.

Today, the social media have become more than just tools connecting long-distance friends. Users can post and discuss and share links at the click of a button. Facebook, Twitter, and LinkedIn are no longer popular only with the general public—they are now among the top social networking sites used by corporations and medical associations to communicate with members and consumers.¹ Although not a networking Web site, YouTube has also become a popular choice for mass communication, and thousands of medical smartphone applications have flooded the market.²

SOCIAL MEDIA FOR HCPS

Apart from Facebook and other mainstream networking Web sites, physicians have formed other social media outlets.

Doximity. Restricted to health care providers (HCPs), this site enables contact with former classmates; provides information on 24-hour pharmacies, hospitals, and labs; and allows users to send messages that are compliant with Health Insurance Portability and Accountability Act (HIPAA), which protects the privacy of patients’ personal medical information, to select colleagues.³

Student Doctor Network (SDN). This nonprofit site started as a grassroots community but has emerged as one of the most comprehensive student-driven Internet resources. SDN is free and hosts discussion forums with more than 4 million posts that offer advice, information, and support.⁴

AAO Community. The AAO has implemented software solutions to facilitate online communication among members.⁴

Eyetube.net. With a format similar to YouTube, Eyetube.net is a leading source for high-quality, fully narrated ophthalmic surgical videos.⁵ It also includes discussion threads.

With more than 50% of Americans using Facebook6 and 75% of households engaging in social media networking,7 these Web sites provide the health care community with opportunities for communication, information gathering, and relationship building.

ADVANTAGES OF USING SOCIAL MEDIA

Social media technologies provide companies with dynamic, innovative ways to promote products and engage consumers. For instance, product descriptions can be posted on sites such as YouTube. However, these practices must be employed with care, or adverse repercussions can result, as is discussed below. Medical associations can use Twitter, Facebook, and blogs to alert members to regulatory and research developments. Companies may foster greater interaction by responding to consumers’ comments and questions or asking consumers to submit information on how a product has improved their lives—information the companies may in turn use to advertise products.

HCPs themselves can use social media to provide expert advice and share medical knowledge through discussion forums, to work with patients through health-related support groups, to promote public health messages via Twitter or other sites, and—under the appropriate circumstances— to treat patients. HCPs can also engage pharmaceutical marketers through these media, providing more control over the information they choose to receive. Further advantages of social media to the health care community include going beyond professional networking, bridging physical gaps between HCPs, and providing a medium for immediate feedback. As a supplement to the interpersonal communication that takes place at meetings and conferences, HCPs can exchange personal information and connect via social media. Typical profiles include pictures and personal information, adding another layer to the relationship.

Physical gaps are closed with the use of social media, and HCPs can now communicate with each other wherever they are in the world. As long as there is an Internet connection, collaboration is possible. Additionally, HCPs can give and receive immediate feedback to posts. However, this can also be a disadvantage if the feedback is negative and it is shared multiple times before the HCP is aware of the post.

APPROPRIATE EXCHANGES AND MITIGATING RISKS

Just when regulatory entities thought they had covered all aspects of marketing, communication, and brand management, social networking sites have caused new disruptions. The rules regarding use of social media for health care purposes are, unfortunately, in most instances undefined. Manufacturers have faced the most difficulty, with the US Food and Drug Administration (FDA) issuing letters regarding content on social media sites but not releasing clear guidelines to govern interactions.

Recently, the pharmaceutical firm Warner Chilcott received a letter from the US Food and Drug Administration (FDA) referencing a YouTube post discussing its product Atelvia (risedronate).⁸ The FDA claimed that the video omitted material facts and contained misleading claims regarding dosing, and he company was told it failed to submit Form FDA-2253 (Transmittal of Advertisements and Promotional Labeling for Drugs for Human Use). The video has been removed from YouTube. In another example, Novartis received a letter from the FDA after it used the Facebook Share application⁹ to promote the leukemia medication Tasigna (nilotinib). The FDA criticized the company’s ad tactic, saying it did not provide enough information to consumers about the drug and that it “makes representations about the efficacy of Tasigna, but fails to communicate any risk information associated with the use of this drug.”⁹ The widget was removed. These two examples demonstrate that, despite the ability to freely share information, not everything should be shared via social media. HCPs should adhere to their institutions’ professional standards, rules, and regulations.

Due to the public nature of even the most restricted Web sites, HCPs must ensure that their posts do not contain personally identifiable patient information. Names, biographical data, demographic data, and specific patient examples should be avoided. When in doubt, consider what patientprivacy standards would require. Additionally, even though pharmaceutical companies would likely be held responsible, HCPs should avoid making off-label comments or having off-label discussions through any social media outlet.

While waiting for regulatory guidance to become more settled, HCPs should approach social media as they would a publication or other communication. Consider the following: (1) establish a specific framework and process to review social media content; (2) train employees to monitor social media activity with specific criteria; (3) work with regulatory bodies to develop a customized monitoring protocol that meets the needs of a specific medium; (4) discourage the use of personally identifiable information. For instance, on sites such as Facebook, change privacy settings so only you can view content on your wall or consider disabling links to post on your wall, encourage patients to send specific questions privately, and add warnings to the terms-of-use section; (5) consider the use of independent moderators if you are hosting facilitated or moderated discussion forums; (6) consider strict limitations on discussion topics and review postings; (7) maintain patient privacy; and (8) maintain the required standards of professionalism set forth within your institution.

CONCLUSION

The use of social media presents opportunity for expansion of health care services. These outlets should be employed with the same precision as a LASIK procedure: assessed for pros and cons and directed and controlled with the utmost care to avoid damage. They should not be feared but rather understood, and in return their benefits will be appropriately enjoyed.

Carla-Marie Ulerie, JD, MBA, is an Associate with Huron Consulting Group. She may be reached at tel: +1 202 585 6853; fax +1 202 585 6801; e-mail: culerie@huronconsultinggroup.com.

Mark DeWyngaert, PhD, MBA, MA, is a Managing Director at Huron Consulting Group. He may be reached at tel: +1 646 277 8817; fax: +1 212 785 1313; e-mail: mdewyngaert@huronconsultinggroup. com.

1. The eBusiness Web site.The top 15 most popular social networking websites.http://www.ebizmba.com/articles/social-networking- websites.Accessed May 12,2011.
2. Medical News Today Web site.Pharma goes mobile:making the most of the app opportunity. http://www.medicalnewstoday.com/articles/220143.php.Accessed May 12,2011.
3. Doximity Web site.https://www.doximity.com/?gclid=CP7fud-W3qgCFcO8Kgod1GOLFQ.Accessed May 12,2011.
4. Doan A.PIO Web site.What’s the buzz about social networks? http://www.medrounds.org/ophthalmologypearls/ 2010/02/whats-buzz-about-social-networks.html.Accessed May 12,2011.
5. Eyetube Web site.About Eyetube.http://www.eyetube.net/other/about.asp.Accessed May 12,2011.
6. Sebastian S.PR Daily Web site.Study:51 percent of Americans use Facebook.http://www.prdaily.com/Main/ Articles/Study_51_percent_of_Americans_use_Facebook_7826.aspx.Accessed May 12,2011.
7. Diana A.InformationWeek Web site.75% of U.S.households use social networking. http://www.informationweek.com/news/storage/virtualization/225700333.Accessed May 12,2011.
8. PharmaLive Web site.Warner Chilcott gets letter under FDA ‘Bad Ad Program.’ http://pharmalive.com/news/index.cfm?articleID=780050&categoryid=9&newsletter=1.Accessed May 12,2011.
9. O’Brien E.Siren Interactive Web site.FDA cracks down on social media medical ads.http://sirensong.sireninteractive.com/socialmedia/ fda-letter-to-novartis-over-facebook-widget-explained/.Accessed May 12,2011.

TAKE-HOME MESSAGE

• Facebook, Twitter, and LinkedIn are among the top social media sites used by medical associations.
• The social media provide a means for HCPs to communicate with each other from anywhere in the world.