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As of August 2009, only 18 pharmaceutical companies were using Twitter, only a few of those were actively Tweeting, and only one encompassed a branded effort. Johnson & Johnson has been the most active, with daily Tweets from Director, Media Relations Marc Monseau and Director, Video Communications Rob Halper. Novo Nordisk was the first pharma company to venture down the branded Tweet route with its Race With Insulin Twitter page, twitter.com/racewithinsulin. Other big pharma company names on Twitter include: AstraZeneca, Boehringer Ingelheim, GlaxoSmithKline, Novartis, Pfizer, and Roche. To find a complete list of Twitter pharma accounts, as well as branded and nonbranded sponsored patient communities, physician and nurse communities, hospital social media sites, and healthcare-related Facebook, YouTube, and MySpace accounts, log on to Jonathan Richman’s Dose of Digital blog. Mr. Richman is director of business development at Bridge Worldwide; he’s also single-handedly trying to change the way pharma and healthcare companies use digital marketing, including Twitter. As part of this, with the help of several other social media consultants, he has created a wiki with more than 20 categories of healthcare social media sites. To see the most current and complete list of pharma Tweets to date, visit doseofdigital.com/healthcare-pharma-social-media-wiki. Mr. Richman says Twitter is analogous to walking into a cocktail party where many conversations are going on at once. “Some conversations you walk past and ignore; some you listen in on, but don’t participate in; others you jump in wholeheartedly and contribute to,” he says. “Very few people stand in the corner at a cocktail party and shout out their message, all the while ignoring everyone else. But this is essentially what many pharma companies are doing on Twitter, and they will lose followers when they find out that it is just another one-way conversation.” Earlier this year, the Web analytics company Compete ranked Twitter as the third most used social network, which puts the number of unique monthly visitors at around 6 million and the number of monthly visits at 55 million. In February 2009, Nielsen ranked Twitter as the fastest-growing site in the member communities category, and in May 2009 it ranked as the fastest-growing Web brand, increasing 1,448% year over year, from 1.2 million unique visitors in May 2008 to 18.2 million in 2009. Although this ranking still puts Twitter behind Facebook and MySpace, the most recent hype has created a greater awareness of the three-year-old social networking tool. The increased use has piqued a mild interest among the pharma industry regarding whether having a Twitter account is advisable from a marketing point of view.
Making a Business Case for Tweeting
The big question on everyone’s mind is: what is the business case for Twitter? Many early adopters, like Mr. Richman, are beating the drum for more companies to participate in the medium, but if pharma companies are waiting for proof in the form of a traditional business case before jumping on the Tweetwagon, they are probably not going to be rewarded for their patience. Like many other modes of marketing, Twitter may cause a lift in brand awareness, but those results are purely anecdotal. Traditional metrics and ROI measurement do not fit into the untraditional Twitterverse. There are ways to monitor results, our experts say, with newer measurement methods, such as sentiment metrics, engagement metrics, and media impressions. According to Meryl Allison, director of life sciences at Deloitte Consulting, although it may be difficult to track a direct connection to revenue from Twitter activity, marketers can track the size of a Twitter user community as well as the tone and frequency of reactions to Tweets. Ms. Allison says the clear benefits of the social networking tool, such as encouraging word-of-mouth messaging to a broad population at a limited cost, are substantial. Twitter also can help companies break through the clutter and reach physicians when they are receptive to receiving information with small bits of data, rather than trying to squeeze into their offices vying for time when they are busy seeing patients, Ms. Allison says. Janet Carlson, founder and CEO of One Eleven Interactive, has little patience with naysayers of Twitter, ROI or no ROI. “I think at this time it would be challenging to see a change in sales from engaging with Twitter — any increase could be coincidental, especially if the increase happened, for instance, right after a Tweet,” she says. “But Tweeting is free, and it’s not like marketers have to reinvent the wheel; it’s just blasting information down another pipe. It’s so easy, why not do it?” Especially, Ms. Carlson says, since both patients and physicians are looking to drug companies for information, Twitter provides another designated vehicle for providing this information. “This is a timely channel and a place where pharma companies can start to build trust with their customers,” she says. “If people want to hear what companies have to say, then why wouldn’t they talk to them? I say, Tweet on.” Not Your Traditional ROI Zoë Elliott, who recently left her director position at Sapient to become a consultant, finds the industry’s need for ROI in social media “a little ironic.” In her experience, ROI has been difficult to track for many different types of media, but some marketers are now using the lack of a traditional ROI as justification to lay low, she says. “Since the digital age, pharma has flown the ROI flag as one reason to not test unfamiliar waters,” she says. “Yet online is one of the most measurable mediums there is.” Offline media can also be more difficult to track. For example, Ms. Elliott says it can be difficult to quantify a TV DTC campaign unless an extensive chain to purchase is being followed. “Online, there is a greater ability to track behavior, segmentation, or even intent, and to do so cost-effectively,” she says. “To make a business case for social media, companies need to look at more qualifiable data and tie those data back to an integrated marketing plan.” Some Twitter users have come up with their own set of metrics to gauge outcomes. According to Faruk Capan, CEO of Intouch Solutions, there are ways to measure results, but the methods are new and not the metrics people are used to. “Some clients have developed scoring systems for measuring the number of mentions of their companies on Twitter,” he says. “For example, a mention gets so many points, a full conversation gets more, the number of links clicked and the amount of exposure a site receives before and after someone does a search earns X number of points.” Mr. Capan also says using Twitter requires a wait-and-see perspective. “I equate Twitter to sending out press releases via the newswires — send it out and see what happens,” he says. Several social media enthusiasts believe that the effect on brand awareness and eventually sales can be measured on Twitter and all social media. “I disagree wholeheartedly with the idea that there is no way to measure results on Twitter,” says Sally Church, Ph.D., executive VP, Icarus Consultants. “Metrics and ROI of social media can be easily measured, and what can be measured can be managed. Start with a baseline, then measure the impact of Twitter, just as with any traditional PR tactic.” Kevin Kruse, founder and president of Kru Research, says to test the effect of using Twitter for direct marketing, he created an account for a fictitious insomnia drug, and then he measured interested followers. “What we found is that a company can, in fact, use Twitter for a brand in a similar fashion to direct e-mail or other direct media channels and get good results,” Mr. Kruse says. The experiment, as Mr. Kruse calls it, was ongoing at press time, but he had completed two phases and was headed into the third. The first phase entailed testing responses to different Twitter profiles. The second phase gauged what impact the profile photo had on response rates; conceptual photos seemed to get the best results. Phase three will be to see if followers will click on links provided to them in value-added Tweets. Mr. Kruse says he was inspired by the positive results that other industries, such as the computer market, were experiencing. “Companies such as Dell are getting real clicks and real dollars, so we set up an experiment to find out if a pharma brand manager could use Twitter as a promotional tool,” he says. The results were surprising, even to Mr. Kruse. The fictitious drug account earned a 1% to 5% response rate with only the drug name and logo, an 8% response rate with a headshot of the “brand manager,” and a 10% response using an artsy image of a woman sleeping on a pillow. Mr. Kruse says his team tried a fourth test, which ended up being the most successful: a profile featuring a person with chronic insomnia who was identified with an unbranded Website related to getting better sleep; that account received a 14% response rate. “These results show that it is worth it for pharma companies to take a hard look at Twitter to determine how to best use it,” he says. According to Christopher Schroeder, CEO of HealthCentral, the benefits and business case for Twitter will eventually emerge, much like any new medium. “Discussions around finding a business case for Twitter remind me of the folks in 2001 who said search would never be an advertising medium,” he says. “Anytime a connection is made with people that is useful, on their terms, and establishes a relationship, the metrics will follow. Right now, the cost of Tweeting is almost zero. The experimentation, learning, and engagement are likely invaluable. That alone is a significant ROI.” Jack Barrette, CEO of WEGO Health, agrees. “The classic ROI for Twitter will come when companies become engaged at enough scale to track new prescriptions and refilled prescriptions through pharmacy data match-back,” he says. “Right now, we can track perception of a pharma brand among the most active social media users, the consumer opinion leaders; we’ve found these opinion leaders are more likely to recommend a brand after engaging with the brand through social media.” There is as much of a business model to be made for the industry to use Twitter as there is for blogging, Mr. Richman says. “Pharma companies may not sell more pills by using Twitter, but it is part of a larger communication program,” he says. “Any company that increases transparency and provides greater access to their customers will yield long-term results. The pharma industry is no exception.” Mr. Richman observes, however, that what most pharma companies are Tweeting on Twitter does not serve the purpose of increasing transparency or improving access. Most companies appear to be using the medium to send out press releases rather than communicating person to person, he says. “Twitter is built on the belief that there’s supposed to be an interaction, which is why there is the ability to reply and send direct messages,” he says. Anticipating one-on-one conversations with everyone who is following a Twitter account can be daunting. Mr. Barrette suggests focusing on the value of having a few virtual friends. “There is only a small group of people a company needs to engage with on a truly one-on-one level,” he says. “Companies make the mistake of looking at the vastness of Twitter as having to boil the ocean. Instead, they should focus on spending time with health activists, consumer opinion leaders, by looking at their behavior online and their frequency and commitment to the topic.” Mr. Barrette also suggests tentative companies use search ads as a model for using Twitter. “Like your SEM campaigns, a Tweet can use 140 characters to mention the brand but not the indication, and pharma companies can do this all day long,” Mr. Barrette says. “It’s a great opportunity to watch a conversation and to provide a relevant Web link that will bring value in context, in real time.” Craig DeLarge, associate director, e-marketing and relationship marketing, Novo Nordisk U.S., says forget about ROI and think about where the customers are. “Twitter is like other promotional tactics — it cannot be tied directly to sales, yet that is where the customer is, and marketers have to keep up with the customer,” he says. An Educational Opportunity Not only does the industry need to start out with the intention to educate people or support patients about their health through posts on Twitter, but Twitter will force healthcare marketers to think about their jobs differently. “Twitter is a relationship space,” Mr. DeLarge says. “As customers continue to engage, then the product needs to be there, and if the product meets the customers’ needs through value-adds such as content and support, well, then, and only then, the company has earned the right to talk about business, purchases, and transactions. But first, companies must establish a trusting relationship.” At press time, Novo Nordisk was the only pharmaceutical company to host a branded social media effort. Indianapolis race car driver Charlie Kimball has partnered with Novo Nordisk to prove his high-performance career is possible with diabetes (Twitter.com/RaceWithInsulin). Mr. Kimball discusses his challenges with coping with Type 1 diabetes and posts messages about using Novo Nordisk’s Levemir to treat his disease. Despite the lack of traditional metrics and ROI, pharma companies that have ventured into the space have found value. Roche, for one, found Twitter invaluable during the recent outbreak of the influenza virus. “As a company that makes one of the leading influenza treatments, we posted links to available educational material and media backgrounders on influenza, which we believed would be beneficial to our audience,” says Sabine Kostevc, coordinator, global Internet presence at Roche. “We also received media inquiries for additional images and b-roll, and we were able to address these requests directly via Twitter. User feedback has been favorable.” AstraZeneca not only listens but also participates in the conversation, says Tony Jewell, senior director of issues and policy communications. But the company gains the most value from listening. “Before we launched our @AstraZenecaUS account, our company was already the subject of numerous Tweets, so it made sense to join the conversation,” Mr. Jewell says. “We not only want to be part of conversations about important health topics, but we also want to listen to what people are saying about the company, the industry, and most importantly, their health.” AstraZeneca’s presence on Twitter provides another channel for reaching a targeted audience with its own news, as well as the company’s perspectives on health issues, Mr. Jewell says. “Since joining Twitter earlier this year, we have gained more than 1,500 followers and have received positive feedback from reporters, industry colleagues, and even some industry critics,” he says. AstraZeneca tries to create Tweets that are fresh and meaningful. One way is by tapping employees who attend events and Tweet their impressions in real-time. For example, when members of AstraZeneca’s R&D organization attended the BIO annual meeting, they sent Tweets about the event and the presentations in which company representatives were involved. “As the health reform debate continues, we will continue to Tweet AstraZeneca’s perspectives, as well as the resources that we’ve found useful,” Mr. Jewell says. “We are trying to constantly improve the newsworthiness of our Tweets, and the number of re-Tweets that we receive is a useful indication of whether our followers find things interesting.” Examples of Tweet-worthy topics that the company intends to engage in include information about patient assistance programs and other patient-support programs. For Roche, the main value lies in “listening,” which allows the company to better understand what is top of mind for its audiences and to have an early warning on arising issues. Ms. Kostevc says the company also finds it useful to be able to respond to questions and point readers to relevant information. “We believe it’s important to listen to issues that are percolating, such as news on influenza for instance, and publish links to information already in the public domain that is relevant to those conversations,” Ms. Kostevc says. “This could include information from our own channels as well as re-Tweets from other sources or references to third-channel sources, such as studies and news commentary.” As a company in a highly regulated industry, Roche does not include marketing or promotional content on its Twitter account, but it strives to cover all topics that might be relevant to its audiences. “As with other media, it is important to understand who is following a discussion, what topics interest them, and then respond in a timely manner,” Ms. Kostevc says. “Publishing news releases is certainly a good start, but this should be coupled with value-added information such as educational content, videos, and fact sheets, as well as responding to questions.” Other Tweets could include alerts on upcoming events, links to third-party news commentary or industry information, and occasional polls on relevant topics, she says. 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