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FDA Social Media Hearings: Day 1 Wrap Up

by DONNA MARIA COLES JOHNSON on November 2, 2009

Today, I attended via webcast the FDA’s hearings on the use of social media to promote medical devices and drugs. The hearings started at 8:00 this morning and I listened uninterrupted until around 3:00, and then off and on after that. The speakers included drug companies (including some that also make cosmetics, such as Johnson & Johnson), medical device manufacturers and suppliers, physicians groups, health-focused websites and bloggers (all sponsored by drugs and medical device companies), industry and advertising trade organizations, public interest and consumer groups, attorneys and social media strategists.

healthcare devices and drugs

An “individual consumer” is listed as a speaker, and I presume she will speak tomorrow. Each speaker spoke for an allotted period of time (some were allotted a lot more time than others), and the FDA officials present were given a chance to ask questions after each presentation. The FDA representative were fully engaged and asked a lot of good questions on all sides of the issues presented. The hearings will conclude tomorrow but I will not be able to attend. The FDA has promised to make a full transcript publicly available (though it’s not clear whether there will be a charge for them). When it does, I will share the link with you, along with more of my impressions.

While this 2-day round of hearings concerns drugs and medical devices, it is my belief that whatever the FDA does in these areas will form at least some of the basis for what they eventually do where food and cosmetics are concerned. I want to make sure that small and independent businesses are positioned to positively impact the process, and informing ourselves at the hearing stage is the first step in that process. Note that I am not an expert in the drug and medical device field so I am sort of learning as I go. If anything published here is incorrect or requires clarification, I will make sure that happens in a way that fully and fairly informs you in future blog posts.

While a variety of views were expressed today, and there are numerous differences of opinion, there we some consistent themes. Here is a quick wrap-up of my initial impressions.

  1. Levels of Corporate Responsibility. Everyone seems to agree that full and complete disclosure and transparency must exist with respect to any promotional content that is created or sponsored (directly or indirectly) by drug and medical device companies (I’ll call them “pharma” for short). From there, the suggested levels of corporate disclosure responsibility differ greatly.

    Some speakers (in particular Diana Zuckerman of National Research Center For Women & Families) suggested that companies should be responsible for content whether or not they actually sponsor it, and whether or not they even actually know about it. Ms. Zuckerman suggested some sort of social media user fee in order to fund FDA regulation in this area. (This was a very scary proposition and I’m keeping a close eye on such suggestions.)

    Other speakers, predictably pharma companies, were less willing to embrace the notion that they should be responsible for third party content over which they have no real control. Non-manufacturer companies like health-focused websites were very concerned that whatever action is taken should not affect their ability to maintain the pharma sponsors that form the backbone of their business models.

  2. Wikis. Wikis, online portals that can be edited by anyone, regardless of expertise, were the subject of much discussion. Everyone agreed on the power of wikis, including Google Side Wikis, and most seemed to agree that they present potential problems where drugs and medical devices are concerned because anyone can modify wiki content at any time, and no special expertise is required in order to do so.

    There was also discussion of Wikipedia’s policy to delete promotional material, and how, in practice, that does not always happen. It was clear that the sort of “crowdsourcing” through wikis presents significant concerns as data continues to indicate that consumers rely largely on the Internet to collect health-related information.

    The obvious issues revolve around corporate responsibility for third party content on wikis — what responsibility do companies have to monitor the content? What responsibility do they have to actually force the removal of content that is incorrect? No one had good answers to these questions, but they are issues for pharma, just like they are issues for all businesses large and small.

  3. 3 C’s. Rohit Bhargava, Senior Vice President, Digital, Strategy & Planning Group, Ogilvy 360 Digital Influence (who also maintains his own blog here), offered an interesting approach. He suggested a “3 C’s” approach to determine a company’s responsibility for online promotional content.

    (1) Creation: If the company created the content and the content has not been altered by third parties in any way, but instead exists in its original form, the the company is fully responsible for the content.

    (2) Collaboration: If the company worked directly or indirectly with the creator of the content to create the message, the company is responsible for the content and full disclosure and transparency must apply. The question is, of course, what constitutes this “full disclosure.” There is discussion of a “one-click” mechanism that allows people to view the content, and then with “one click,” be taken to an authoritative site with all of the disclosures and risks fully addressed. (Some people like this idea. Consumer groups tend to think it does not go far enough.)

    (3) Compensation: If the company funded creation of the content or somehow compensated the creator of the content, the company is responsible for the message and full disclosure is required. (Again, “what is full disclosure” is the issue.)

    Unless the promotional content fits one of those categories, Bhargava urged, then that company cannot be responsible for that content. While it benefits everyone for companies to correct or even remove misinformation, one cannot expect a business to police the entire Internet, and/or be held responsible for content that business cannot remove or modify themselves. You can read Bhargava’s post about today’s hearings at his Ogilvy 360 blog.

Challenging Issues

These issues are challenging indeed, and this post barely scratches the surface. The hearings this week concern drug and medical device companies specifically, and even though companies participating in those industries are regulated very differently than companies in the food and cosmetics industries, the core questions are very similar. What if third parties publish content about your products or the ingredients used in them, and that information is incorrect or somehow causes harm to someone else? Are you responsible for that under all circumstances?

What if you are? What if you ask the third party to remove the content, but they refuse? Are you still responsible for the content? are you responsible at all if you did not have direct involvement in the creation of the content? Or are you only responsible if you participated or somehow sponsored or supported the creation of the content? same. What disclosure rules should apply?

Is your head spinning? Mine is.

What About Small Businesses?

One thing that bothered me about the hearing today is the the phrase “small business” was never uttered. I know that most drug and medical device firms are not small and independent business owners. But like all federal agencies, the FDA is under Congressional mandate through the Regulatory Flexibility Act to specifically analyze the impact of their actions on small businesses and to seeks the least burdensome means of regulation so that small businesses are no unnecessarily adversely impacted.

It seems to me that the FDA cannot do that on this issue unless it actually hears from small businesses. I think that a small business or an entity representing small business interests would have been a positive addition to today’s hearings. I’m not sure what can or should be done about that where the drug and medical device issues are concerned, but since the food and cosmetics industries are composed of a very large number of tiny businesses, we will have to see what can be done to get a seat at the table when the FDA turns its attention to food and cosmetics.

Remember, if you want to tune in tomorrow morning, you can do so at this link.

Oh! By the way, if you want to purchase a DVD of the proceedings, the price is only $140 at this link. I bet you know what I’ll have to say about that when I get the chance, don’t you?

Question: What do you thing of all of this? Do you have any opinions one way or another? If you tuned in to the hearings, please feel free to fill in what I might have left out.

Related Posts:

  • Since you mentioned my testimony at the FDA meeting, I want to clarify what I said: I suggested a user fee for pharmaceutical and medical device companies using social media to advertise their products. Like existing user fees for those companies, user fees are in proportion to the size of the companies; the smallest companies do not have user fees. Currently, the larger companies pay user fees to get their medical products reviewed by the FDA so that they can be approved. Either all taxpayers need to pay, or the companies need to pay. User fees keep our taxes down.

    The fee is not on people using social media, it is to support staff salaries for FDA to evaluate the accuracy of medical claims made in social media if those claims are paid by companies. That way, any person using the Internet or other new media to gather information about the safety and effectiveness of a cancer drug, for example, could be assured that the information is accurate, not paid advertising disguised as honest opinion of individuals. That helps all of us.
  • Hi Diana: Thanks for stopping by my blog and shedding more light. I don't recall it being made clear that small companies would not have to pay any user fees under the scenario you proposed. That was my concern -- that tiny companies whose proportionate contribution to the risks associated with using the Internet to gather safety information would have to pay such fees. It's good to know that's not the case, and that a "graduated" sort of scale is involved. Thank you again for your input. I enjoyed your presentation yesterday.
  • Thanks again Donna Maria for keeping up the tweets on this webcast! I found the webcast extremely beneficial for my company, long but nonetheless beneficial. First, let me say that we are a small business. As a small business that has an exempt class 1 medical device, today's webcast was educational for those of us who are lay people in this industry.

    We created and Patented a product that shows women how to perform a breast self exam. Our website (www.bckshirt.com) provides information on Breast Cancer, Symptoms, Prevention, etc. along with our product, The Breast Chek kit. We also have a Non-Profit arm that goes into the community and educates women the early detection of breast cancer, etc. We provide content information that comes from a variety of trusted news sources, federal agencies, medical journals, and other renowned breast cancer research organizations. We also market and advertise this information along with our product. Our BOD consists of Board Certified Breast Cancer Surgeon, RN's and MPH persons.

    We do not endorse or promote any breast cancer drugs, pharmaceuticals or procedures of any kind on our website or social media at this time. We do however provide breast cancer educational literature from various pharmaceutical companies, etc. that are not drug related.

    This webcast helped us to become even more aware of the content [ and source] that we receive and make available on our website and social media. Over the course of the day, speakers addressed a set of five questions the FDA is looking to answer, and this is my take away from the presenters as it relates to:

    1. Accountability
    2. Fulfilling regulatory issues
    3. Correcting misinformation
    4. Linking
    5. Adverse event reporting

    It seemed that much of the day was spent on educating the FDA on the fundamental value of the Internet and online information. My take away was that the bulk of the discussion can be drilled down to 3 key points, which I think most seemed to be in agreement on:

    1. The FDA should provide clear social media-specific guidance- Michele Sharpe of Eli Lilly stated this early on and it seem to be reiterated throughout the day.

    2. Accountability should be based on editorial ownership. Pharma companies seem to all agree that they should be fully accountable for all the content they create, control or promote. BUT it is unreasonable and impossible to be accountable for content that they have no editorial control over.

    3. Support for 1-click rule. Several presenters conveyed recommendations in support of the 1-click rule for linking to safety information as a solution for media formats with limited space. Google and Yahoo! also addressed the unintended consequences of the recent violation notices the FDA sent out around keyword ads; the result is a decrease in transparency and information, leading to a decrease in clicks. The unbranded links to brand sites currently in use don't give consumers enough information to compel them to click. COULD RELATE TO SEO FOR ANY BRAND.

    There were also a number of other interesting tactical recommendations.

    3C Rule. Ogilvy 360’s Rohit Bhargava made it simple: How do we determine accountability? Creation, compensation, collaboration. If creator did any one of these, they are accountable. As you mentioned.

    “FDA Approved” logo. The concept of a logo or icon indicating a destination or resource is “safe. Might be a good idea.

    Creative media formats for presenting “fair and balanced” information in small spaces. It doesn't have to be long chunks of text; Yahoo! and Johnson & Johnson both presented a number of alternative formats, such as using rich media banners, rollover and scrolling functions. (My personal favorite)

    User experience. The FDA should help by providing guidance to companies for writing patient information in a way that is clear and not confusing; i.e., watch someone search and see what they're actually doing. In other words...more analytics.

    Hashtags. John Mack of Pharma Marketing News suggested that the FDA should assign product-specific hashtags as a vehicle for FDA to gain history and monitor Twitter conversation. HMMMM

    To some this may have been a very boring webcast. However, there were many things that could be useful to any small business as it relates to content, content source, SEO, and analytics on their sites. I also think that this information could be especially useful to Indies as it relates to their product ingredients. What do you think?
  • Linda: How exciting to know a small business owner with a patent on such a useful medical device. Kudos to you! Thanks for sharing your notes here and reminding all of us of the value of keeping track of the kind of useful information shared yesterday. Most small businesses of course don't have the resources to listen to and digest these kinds of hearings and it's so valuable and appreciated that you took notes and shared them with everyone here. Thank you for that! I wish you continued success with your company and the great work you are doing to support women's health!!
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