Using Social Media for your Brand. 1. Listen & Learn 2. Internalize & React 3. Respond & Engage

1. Using Social Media for Your Brand
How to start
How to keep going
How to stay out of trouble
How to be effective and relevant
Developed by Michele Bennett
Chief Operating Officer, Wool Labs, LCC
In collaboration with QooQoo

2. About Me
• Discovery, Clinical and Regulatory Affairs professional, computer
engineer, behavioral and data scientist
• 25 + years experience in Pharmaceuticals, Devices, and Biotech
including Marketing, Competitive Intelligence and Market Research
• Co-founder and COO of Wool.labs which creates tools for social media
monitoring and analysis (WebDig), engagement (DigBar), social
search, predictive intelligence (Spark), and more.
• The company has been working with social media in Healthcare for 5
years – longer than just about anyone else.
• We publish our own studies as well as work with clients across the
healthcare continuum.

3. Lions, Tigers and Bears, Oh My
• How did the Internet become so scary?
• We all use it every day. We panic when the power is off (and the
Internet goes down). A day without the Internet eats away at most of
us; we feel unproductive and out of touch. We capitalize Internet.
• So the saying, “with great power come great responsibility” should
apply to the Internet. But it does not.
• The Internet holds great power – powerful content, the power to
influence, the power to make people move, the power to effect change
• The Internet has no accountability – you can put anything
there, regardless of truth, validity or rationality. (Psst...It lies).
• The Internet knows everything, knows nothing, contains billions of
important pieces of information and even more junk.
• So, it is Chaos and Wonder. Power and Lies. Data, data and more data.
• And we can’t get enough. But we hesitate to use it well.

4. For Us, What is Social Media?
• Tens of millions of people using the Internet for medical advice, to
check their physicians’ diagnoses, to share their health experiences, to
provide advice to others, to self-treat, to break all of the rules told to
them by their doctors, to define their healthcare
• It’s a medium that you cannot control. Influence maybe but not control.
• It’s truly interactive – two-way, ten-way, ten thousand–way
communication.
• It’s everywhere – computer, tablet, phone, TV. No other medium in
recent history has captivated people so.
• It moves lightening fast and cannot be prematurely halted.
• It generates millions of connections, data
points, conversations, opinions, beliefs – simultaneously and in as many
directions.
• And if harnessed just right, the most powerful marketing vehicle we
have ever had at our disposal.

5. Why Take on The Challenge?
• Tens of millions of people talking about your brands and you’re not in
the room.
– If that was happening in a real room, you would not just stand by and watch. (Unless
everyone all had spears and then I might just kind of just slip away, but that seems
unlikely.)
• Everyone who impacts your products is there –
patients, caregivers, physicians, nurses, managed care
professionals, pharmacists
• And then there are some interesting stats:
– Less people are going to their physicians - Insured Americans are using fewer
medical services, raising questions about whether patients are consuming less
health care as they pick up a greater share of the costs. – Wellpoint 2012
– Compliance is a problem that is costing America’s healthcare system a lot of money
- One-third to one-half of all patients do not take medication as prescribed, and up
to one-quarter never fill prescriptions at all. Such lapses fuel more than $100 billion
dollars in health costs annually because those patients often get sicker. –
PharmaMarketer 2012

6. Why Take on The Challenge?
• More stats: Harris Interactive 2011
– Physicians are wired, online and using social media
– 94% of physicians are using smart phones to communicate, manage personal and
business workflows, and access medical information.
– Nearly 90 percent of physicians use a social-media website for personal use, and 67
percent use it professionally, according to a survey of 4,000 physicians by Quantia
MD
– The number of people looking for health information on the Internet is increasing
every year
– While the percentage of adults who go online (79%) has not changed significantly for
several years, the proportion of those who are online and have ever used the
Internet to look for health information has increased to 88% this year, the highest
number ever.
– Fully 81% of all eHealth consumers have looked for health information online in the
last month. On average, eHealth consumers do this about 6 times a month.
– Very few eHealth consumers are dissatisfied with their ability to find what they
want online. Only 9% report that they were somewhat (6%) or very (3%)
unsuccessful. And only 8% believe that the information they found was unreliable.

7. Why Take on The Challenge?
• What do patients look for: Pew Internet Project 2011
– 66% online for information about a specific disease or medical problem (perennially
in the top spot).
– 56% for information about a certain medical treatment or procedure.
– 44% for information about doctors or other health professionals.
– 36% for information about hospitals or other medical facilities.
– 34% regularly use blogs and forums for health information (60 million people)
– 33% for information related to health insurance, including private
insurance, Medicare or Medicaid.
– 29% for information about food safety or recalls.
– 24% for information about drug safety or recalls
– 22% information about environmental health hazards.
• Access, Reach, Engagement, Frequency – the hallmark of all marketing
converges on the Internet and in social media. There is no venue
bigger, faster or more cost effective to use. So we have to figure out
how.

8. Why Take on The Challenge?
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Highly knowledgeable
Communication
Shared decision-making
Honesty
Listening
Respect
Integrity
Open to differing opinions
Having enough time together
Interested in prevention
Open to more holistic approaches
Supportive
A good teacher
Feeling cared for Patient Values
Patience Most Important Characateristics of
Those Providing Healthcare
Promptness
n = 101
Sensitivity
Flexible
Other, please specify

9. We have Rules
• But our world has rules even when our audience has none
• We have to play but a set of guidelines that govern what we say, when
we say it and who we say it to.
• Our audience says whatever it wants even if it is incorrect, tells others
what to do even if it’s off label, and can have great influence over many
• So in a world where we have to play by rather strict rules with an
audience who has no rules, how do we master social media and
Internet-based dialog and
– Take advantage of having so many ears and eyes for our messages
– Understand and address the concerns of internal departments
– Not get in trouble with external regulators
• That’s what we are going to talk about, try it on for size and
feel, and look toward a path forward

10. Rules of the Game
• Just like any other tool in regulated industries, social needs internal
procedures and policies for use.
• As we can see from where the FDA started in guidelines, no general
social guidelines are going to be forth coming soon
• So organizations will have to create their own way using the guidelines
that we have already.
– No SM guideline will ever allow companies to not include fair
balance because the medium doesn’t easily provide the space.
• So using common sense and existing FDA rules for
communications, companies can move forward.
• Every organization has its own threshold for risk and their own way of
interpreting the FDA guidelines
• But we can provide some foundation for how to get started

11. Rules of the Game
• In a regulated industry, no medium should be used without policies
• What do policies have to cover? You need three:
1. Listen & Learn
2. Internalize & React
3. Respond & Engage
• In general, social media policies need to be
– Brief and direct
– Clear about roles and responsibilities
– Address guidelines, risks and benefits
– Applied internally and well as externally (e.g., include a policy on
employee and employer actions)
– Real, realistic, and implementable

12. What Game?
• Where to start?
• Engagement? Ok, but its usually the hardest place to start and typically
poses the most risk. We never recommend starting here, ever.
• Listening and learning is by far the best place to begin
• Why? Maximum benefit, minimum risk
• Easiest (yes, we know that is a relative term) guidelines to develop, get
approved, use, track, and benefit from and low risk of saying something
by which a letter, warning, internal reprimand or more damages you or
your company
• But effective Listening programs need to also be accompanied with
methods of internalizing and reacting to findings
• If not, brands risk running into internal confusion and even unnecessary
panic and perhaps even external problems.

13. 1. Listening & Learning
• Listening and learning provides fuel and data for any marketing, sales
and communications effort
– Listening programs can be highly measureable, cost efficient and targeted methods
for collecting data on any audience type.
– Ensure that your listening parameters are aligned with brand strategies and always
set metrics for success
• Encourage listening despite perceived risks
– Social media monitoring should be encouraged, and policies should address the
method of monitoring, and what is done with the results.
– A manufacturer can learn first of additional indications and real-world risks that did
not surface in trials. It is inevitable, positive, and responsible
• Its not a one time thing
– Many marketers equate social media monitoring with conducting a one-time market
research project. The results are analyzed, used to guide decisions and
messaging, then the study is placed in a binder next to the one from last year’s sales
meeting.
– However social media is fluid, and challenges and opportunities are perpetual.
– Think of it as a constant source of the latest information you need to know

14. 1. Listening & Learning
• There are tools to monitor the social media in a manner consistent with
existing guidelines
– Any tool you use must pass certain tests around the collection and store of PII and
how any potential non-reportable AE’s are collected and reported to you
• Listening programs can be proactive management tools
– Today’s tweet can be tomorrow’s Today’s Show story. (We’ve seen it happen).
– Social media is an opportunity for a proactive firm to address problems before they
start.
• Guidelines for listening should include:
– Treatment of PII, adverse experiences, unexpected learnings, off label requests and
suspected usage
– Departments involved in listening, tools used and for what purpose, metrics involved
including thresholds for signals
• But don’t focus on the scary and negative aspects.
– Internet dialog contains so much valuable and useful data – competitive
intelligence, market research, drivers and barriers to sales, patient adherence
answers, physician motivators – its all there and your competitors know it too

15. 2. Internalize & React
• Legal & Medical oversight
– Monitoring research should be done with oversight to ensure the methodology
is appropriate, reporting obligations are held, and with legal and regulatory
guidance on how to proceed with discoveries that might have labeling
implications.
• Fear of Adverse-Events is not warranted and not an excuse
– In the almost 5 years we have been monitoring SM, we have yet to come across a
FDA-defined reportable AE.
– People do report problems though where manufacturers can identify and document
instances of recurring adverse events or off-label use
– If a blog, video or chat comment does contain sufficient information for reporting, it
should be routed urgently to the team responsible for reporting AEs.
– This solution is common sense, but “fear of AEs” is one of the largest hurdles facing
manufacturers that wish to engage more deeply with customers.
– You cannot proceed to engagement until you address this concern completely and
this is the stage at which it should be addressed.

16. 2. Internalize & React
• “Not Looking at Internet” is Not a Sound Legal Defense.
– Lawyers are legitimately concerned that evidence of monitoring could create an
FDA expectation that the manufacturer is obliged to read and respond to all of
social media.
– That is obviously impractical and an the FDA will not soon demand manufacturers
to read the entire Internet.
– However if a product issue is identified, trending, and ignored, a poor defense
would be “we didn’t know it was happening because we didn’t use the Internet.”
– It is not unreasonable to expect the FDA to take action on a company that did not
update labeling based on newly evident side effects that are well documented
online. It is also reasonable to assume that manufacturers would be expected to
take reasonable efforts to clarify labeling in prominent forums where patients or
doctors are promoting off-label use. The current guideline is one step away.
• Don’t “Freeze” Corporate Efforts or Look the Other Way
– It’s important that social media monitoring be shared beyond the group doing the
monitoring, so medical affairs or legal can determine if the insights warrant FDA
communication. So in effect, by “freezing” or “avoiding” social media
monitoring, manufacturers may be taking a greater risk than reasonable efforts to
monitor and respond.

17. 2. Internalize & React
• Guidelines at this stage need to include
– Methods for internally reporting issues or concerns raised by dialog including what
to do with labeling concerns, marketing and sales issues, potential legal issues, PR
and communication needs, external affairs and more
– Each department playing a role with listening results needs their own policies
including escalation thresholds

18. 3. Engage & Respond
• Policies for engagement should come after policies for listening and
internalizing
• Monitor First
– A best-practice related to social media is to monitor mediums for a period (3 to 6
months) before engaging
– This gives an organization time to understand the context, and the appropriate
approach for engaging.
• Use existing credible communities
– Manufacturers publishing or hosting social media can be faced with serious
risks, regulatory constraints and cannot do so with objectivity.
– As a result, marketers should look to reach their audience via appropriate social
media sites and tools using paid and earned media.
– Credibility in social media is earned – extremely so. In the current
environment, manufacturers are not completely trusted and biases can be overcome
but by learning and only engaging when you know enough to be perceived as
helpful, which varies by category

19. 3. Engage & Respond
• Know Who Matters (sometimes, it’s a collective Who)
• Social-media engagement requires
– Addressing not just the concepts of “headline risk” – what journalists and the media
have to say but
– Addressing the concerns of communities or individuals with the speed and attention
otherwise reserved to investment or media inquiries.
• Set Guidelines to Avoid Mistakes or Apathy
– Marketing should have clear policies on advertising around social media, and this is
similar to advertising in print or television.
– If the ads are placed adjacent to condition-specific information, they should be
unbranded and not branded unless fair balance on the page can be included.
– Just as manufacturers gain comfort with digital advertising, you will gain comfort
with running ads wherever their target customers are, and not fear ad placement
surrounding uncontrollable social media.
– The ad may be the only appropriate way to reach some patients, and most
consumers know that the difference between ads and other content.
– Actually answering posts in a social forum requires a tool for delivery and
tracking of the post as well as for the simultaneous delivery of fair balance

20. 3. Engage & Respond
• Revise, Review, Processes, & Develop a Crisis Plan:
• For good reasons, manufacturers maintain thorough and somewhat lengthy review
processes.
• However public relations professionals are often granted “fast track” reviews for time-
sensitive matters like product issues or launches.
• Similarly, the process by which ads are approved cannot facilitate handling of a timely
event in social media. Some matters need rapid attention and resolution.
• It is highly possible that at some time in the future, a product recall could involve a
manufacturer directly communicating with customers, rather than shaped by the
media, to probably a much better outcome
• Other industries have social media commentary ready for any major disaster
• All companies should have a “crisis-management guide” that includes mediums for mass
communication that are not dependent on print and television reporters.

21. Armed and Dangerous. Now What?
1. Create your first pass of a listening policy that addresses how data is
collected, who gets what type of information (data, analysis, etc), and
what constitutes a signal or alert of significance, how any issues will
be reported to you, and who gets what if thresholds are met.
• The FDA looks to see if you have a policy and if you are following it. It is a higher risk
to have a policy that you don’t or can’t follow than not having one at all.
2. Define a listening program or pilot that runs 3 – 6 months
3. Test the program against the policies and adjust accordingly
4. While the listening program in running, start on your internalization
and reaction policies. Include marketing, medical, legal, and
communications. Keep them short and direct.
5. Compare your internalization guidelines to the results of the listening
analysis to check for the need for adjustments.
6. Once your Listening and Internalization programs seem to work, then
start on Engagement Guidelines and options.

22. Armed and Dangerous. Now What?
7. Engagement can come in multiple forms. Yes, online but also
offline, in office, via your branded website, in the community, in
hospital. Think about the broader concept of word-of-mouth to find
ways to engage that you already use. The goal is to build trust and
credibility.
8. If you are ready to engage online, use tools to ensure that only
approved responses are used and tracked for
marketing, medical, regulatory and legal review and compliance. Think
about programs in which you seed the online communities without
you directly engaging – KOLs , mentor programs, community
leaders, self-managment tools
9. Be prepared to handle bad news. Know what bad news is and
appropriate reactions internally as well as escalation. The more
prepared the organization is, the less likely it is caught off guard.
10. Listening, internalization and engagement all work together and are
progressive. If you start in the middle, you increase risks with one risk
being the organization will not want to try social again for a long time.

23. Ways Others Use Social Media
Product Launch
Market Research
Market Strategy
Scientific Publication
Patient Understanding and Engagement
Sales Strategy
Physician Influence
Hospital Relationship Development

24. Example Scenarios
Avandia
When bad things happened to good drugs

25. Situation Set Up
• In 2003 and 2004, the benefits for most patients outweighed risks and
for the most part patients were more hopeful; most of patients’
struggles were more connected with diabetes than with the brand.
• In 2005, patients begin to become aware of risks as well as weight gain
and edema. They openly discuss it but feel physicians are largely
downplaying their concerns. Some patients begin to become more
vocal and reach out to be heard. Negative sentiment rises
exponentially.
• In 2006, patients start to connect their concerns to congestive heart
failure. This year showed early warning signs of problems for the brand.
Loss of trust is the next predictable problem.
• 2007 was a pivotal year - where patient trust starts to drop
dramatically. Patients question their physicians and begin to take
control over their medication choices. Patients start referencing
GSK, which in our experience is rarely good. Vioxx comparisons are
raised and legal action is easily predicted to be the next course of
action.

26. Situation Set Up
• By 2008, patients display open hostility to the Avandia, GSK, and even
their physicians. Legal discussions exploded and overtake diabetes-
related conversations in volume. Trust is gone from conversations.
• In 2009, patients become more resigned and loss of trust starts to
translate to the industry. Patients have stopped listening and new
information that could have been used to sway opinions is dismissed.
Conversations move from patients to industry analysts, marketers, and
consumers who are not patients.
• By mid 2010, patients are resolute in their decisions. They are no less
angry at Avandia and GSK but are now also angry at the FDA as they see
the FDA as not listening either.
• At no time during the controversy over the last several years has
anyone reached out to the patient base to explain or reassure. Patients
tried to decipher complex studies and analyses – and, right or
wrong, once they drew their conclusions, they were not going to be
swayed otherwise.

27. Situation Set Up

28. Situation Set Up
Language Intensity Level - Avandia
Measure of the Level of Negativity in Patient Reports
Low = 0--1 Moderate - 2-3High = 4 - 5
n = 2,111
5 5
5
4 4
4
3
3
2
2
1
1
0
2004 2005 2006 2007 2008 2009 2010

29. Opportunities for Discussion
• If this happened in 2012 with the technology available now, what
would you do and when?
• Who should have been involved in listening, internalizing and possibly
engaging?
• Listening would have revealed interesting results. How would you like
to see your company internalize this type of information?
• Should the brand have engaged with patients, physicians, media. And
how? Remember engagement doesn’t have to be in kind.
• In hindsight, so much is obvious. But there are always higher risk
products on the market; maybe those with high benefit but limited
populations. Does that change how a brand proceeds?
• What are the risks and benefits in learning information that may not be
initially well received in the organization?

30. Example Scenarios
Jakafi
Real data powering product launch

31. Situation Set Up
Myelofibrosis Sentiment Index
Ratio of Positive Conversations to Negative Conversations
Range of Index: -100 (all neg) to 100 (all pos). 0 is neutral
2.0
0.4
0.0 0.0
0.0
-0.3
-2.0 -0.9
-1.8
-4.0
-6.0
N = 1054
Confidence Interval = 95%
-8.0
Margin of Error= 2.96%
-8.4
-10.0
-9.6
-12.0
-12.5
-14.0
2000-2003 2004 2005 2006 2007 2008 2009 2010 2011

32. Situation Set Up
Awareness & Support Index
Percent of Treatment Conversations where Patients/Caregivers
14% Discuss Dissatisfaction with Watch & Wait as Treatment Option 13%
n = 1054 Confidence Level = 95% Margin of Error = 2.96%
12%
10%
10%
8%
6% 5% 5%
4% 4%
4%
2% 2%
2% 1%
0%
2000-2003 2004 2005 2006 2007 2008 2009 2010 2011

33. Situation Set Up
Awareness & Support Index
90% Community Members' Disease Knowledge
78% Percent of Conversations by Knowledge-Level Over Time
80%
n = 1054 Confidencel Level = 95% Margin of Error = 2.96%
70%
64%
60% 58%
51% 50% 52%
50% 48%
44% 46% 45%
43%
40%
40% 35%
32%
30% 29%
30% 27% 26%
24% 25%
22%
20%
13%
10% 7%
4% 2% 4%
0%
2000-2003 2004 2005 2006 2007 2008 2009 2010 2011
Zero to Low Knowledge Moderate Knowledge Strong Knowledge

34. Situation Set Up
Awareness & Support Index
Percent of Conversations on Cancer-Oriented Sites Over Time
70% n = 1054 Confidencel Level = 95% Margin of Error = 2.96%
64%
61%
60%
53%
50%
40%
30%
25%
20% 17%
13%
11%
10%
3%
1%
0%
2000-2003 2004 2005 2006 2007 2008 2009 2010 2011

35. Situation Set Up
Pain Points
n = 1054 No Cure
Confidence Level = 95% 9%
More
Margin of Error = 2.96% More
Information
Treatment
25%
Options
16%
More Watch & Wait
Professional 9%
Knowledge
14%
Caregver/Patient
Support
More 20%
Professional
Interaction
7%

36. Opportunities for Discussion
• Jakafi is the first treatment option for patients with myelofibrosis that
actually treatment the disease rather than just addressing symptoms
• Based on what we have shared today, are there recommendations you
would make for the brand team?
• Should they continue monitoring and why?
• Should they engage and how?
• Are there things you can think of that stand out as interesting and
actionable?