Before looking at pharma companies testing out the mobile space, I want to introduce you to another healthcare organization that is diligently studying this channel. A hospital system, you say? Nope. Insurance plan? Sorry. It's actually none other than the US government.
At the Business Development Institute (BDI) Social Communications and Healthcare Conference last month, Centers for Disease Control and Prevention (CDC) Social Media Strategist Ann Aikin presented "Going Social 4 Health Impact," which you can view thanks to VEOMED. Aikin came to New York armed with all kinds of data and some great case studies describing the CDC's efforts on YouTube and in the teen community Whyville. It was her description of a text-messaging pilot, though, that sparked my thinking.
Last fall, the CDC invited Americans to opt in for text messages about a variety of health topics. Want to learn how to fight the H1N1 virus? There's a text for that. At what temperature is my Thanksgiving turkey fully cooked? The CDC suggested 165°F (in 140 characters). It was part of an effort to understand how short-form media could change health behavior and how even small bites of health information could be optimized for a better patient experience.
One key finding: 91% of participants surveyed said the text messages they received were easy to understand—a big win for the CDC's application of health literacy principles to a challenging medium. On the other hand (speaking of turkeys), less than two-thirds of participants surveyed said the text messages were interesting, useful, or relevant. But Aikin said the CDC is undeterred. She said that many of the program's 16,000 participants have turned out to be doctors, and in response the CDC is working on a segmentation strategy to customize its mobile content for different audiences.
As US mobile penetration and usage grows (the latest stats from Mobile Marketing Association here), it's true that the channel is attracting more and more interest from brand marketers abandoning a TV-dominated model. But as Aikin and her colleagues have shown, mobile has healthcare implications that extend far beyond the marketing department. From patient recruitment to adherence strategy, mobile may offer pharma a new competitive edge it can use to offset patent-expiration doldrums, overcome rising drug discovery costs, and create real value for shareholders, patients, and doctors.
How will pharma finds its way to the third screen? Please take out your cell phone (no doubt it's close by) and follow me.
Let's start with one of the first consumer-savvy mobile marketing campaigns in the industry, launched by McNeil Pediatrics (a Johnson & Johnson company) and Augme Mobile. To try it out, text the keyword ADHD to the short code 87415. You'll get back a text message directing you to a mobilized Web site for Concerta. If your device supports mobile Web, click to see a landing page with Important Safety Information about the product, followed by a small but feature-rich site. On the landing page are an interactive screening questionnaire, a coupon link that will send you a Concerta voucher through e-mail, and even a video that played perfectly through my Droid's media player.
The brand raised eyebrows when it launched the campaign in fall 2009, running the keyword and short code on airport advertising displays and a Times Square jumbo screen. In its first 2 weeks, the program delivered close to 5,000 site visits and has had many more in the months since. (Full disclosure: Augme is a HealthEd partner.)
Creating a Brand.mobile can be part of a wide-reaching effort, like Concerta's, or a more targeted program. I got a tip from my former employer, Gold Mobile, about a patient voucher program its mobile health subsidiary launched in January. According to CMO Al Stern, a global pharma company printed keywords and a text short code on 2 million drug samples being distributed through healthcare providers' offices. When patients text the keyword to the short code, they're brought to a mobile microsite with unique voucher codes, which can be redeemed at a pharmacy. Stern said patients without mobile data plans can simply text an e-mail address and receive the voucher via e-mail.
Futurecasting: The Concerta program brings the "wow" factor to a conservative industry—that's for sure. Cell phones? Times Square billboards? Just another example of Johnson & Johnson taking the lead in the alternative media space. Will other pharma brands follow? Augme says yes, and I believe it. One of texting's most powerful benefits is the opportunity to "tag" traditional media, such as magazine ads, with different keywords. Identical Concerta ads in Parenting and Working Mother magazines, for example, might have different keywords. If one keyword strongly outperforms another, brand managers will now have leverage they can use to optimize their media plans.
Drug marketers, though, will need to weigh the benefits of a Brand.mobile against its strategic limitations. While more than 64% of US mobile users sent a text during the 3 months ending in February, less than 30% accessed the Web on their phones, per comScore. In other words, marketers who use the mobile Web must trade audience reach for engagement. That's probably a good deal in a tech-savvy category such as ADHD; maybe not so good in others. While Gold Mobile's solutions offer a hedge, they must also address HIPAA issues
Cell phone adherence
This is one of the most exciting areas of innovation in the pharma industry. Medication nonadherence is a complex and costly challenge for drug marketers, and it stems from numerous factors, including cultural beliefs, social cues, and patient cognitive deficits. Unfortunately, even financial considerations get in the way of patient adherence. My colleagues at HealthEd have worked with a number of vendors on medication adherence programs for clients, and many strong offerings are available. Yet nonadherence still costs the US healthcare system some $290 billion annually, so if mobile technologies can offer an alternative, they are going to be warmly received.
For starters, there is the humble refill reminder. A well-known example comes courtesy of the Schering (now Merck) drug Nasonex, whose Brand.com invites users to sign up for refill reminders through e-mail or text messages. Applications like this one are helpful, and as in other industries, on pharma sites you'll start seeing requests for your cell phone number right next to requests for your e-mail address.
A more robust offering comes courtesy of MedActionPlan.com, which provides tools and plans that help patients adhere to complex pill regimens. Not surprisingly, some of the company's first pharma sponsors are marketers of products in the HIV, transplant, and diabetes categories, including Astellas, Wyeth, and ViiV Healthcare. Recently the company launched an iPhone app (see graphic) that gives smart phone users the ability to identify pills and set reminders through a convenient user interface.
MedActionPlan.com is one to watch. While it's followed a typical Web 2.0 route of providing free access to grow market share, its branded offerings (such as this one for Astellas) offer turnkey reminder technologies for medications dependent on strong adherence.
And then there is Novartis. If you haven't read about Raisin, the ingestible microchip system the company is piloting, you should start now. The product of Proteus Technologies, Raisin involves embedding a tiny chip inside a pill. When the chip hits stomach acid, it triggers an electric charge that is detected by a patch worn by the patient. The patch time-stamps the event, takes a few vital signs, and sends the data via the patient's mobile phone to his or her healthcare provider. Miss a dose? Then the electric charge will fail to trigger, alerting the HCP. In a small Raisin pilot with Novartis blockbuster Diovan, compliance rates jumped from 30 percent to 80 percent in 6 months.
Futurecasting: Michael Crichton dreamed up reconstituted dinosaurs and intelligent microchip swarms, but the best-selling science fiction author would have gaped had he seen Raisin. Unlike MedActionPlan.com, which requires people to proactively manage their medication regimens, Raisin does its work behind the scenes. Its elegant use of the body's built-in electrical system to trigger the patch ensures that complex pill regimens can be managed by and monitored for even the most forgetful among us. Of course, there's a catch. In Jurassic Park, the dinosaurs proved stronger than the man-made fences built to pen them in. With remote adherence programs, pharma must consider whether Americans are ready for the idea of eating microchips and submitting to electronic monitoring. Expect cautious support from the medical community, and a testy fight from consumer advocacy groups, privacy organizations, and bloggers on both sides of the aisle.
Clinical trial management
There will be no need for adherence programs or cutting-edge brand campaigns if promising new drugs cannot come to market. The clinical trial, once a necessary step along the path of commercialization, has become a strategic lever. Manufacturers able to master patient recruitment and study management—both of which grow more challenging each year—stand the chance to reap the rewards of regulatory approval and billions in healthcare spend. But it's easier said than done.
For one thing, patients are simply not learning about the option of joining a clinical trial. The pharma industry is only starting to address this problem, which is particularly severe in oncology, a disease category in which only 3 percent of adult patients are enrolled in a trial. For another thing, clinical trials are plagued by the double whammy of medication nonadherence and inaccurate patient-reported outcomes. Mobile solutions that address these challenges will be sure to get a close look from pharma in the years ahead.
Pfizer has begun that due diligence by piloting a text messaging program to ensure that Phase I volunteers stick to their medical appointments. Patients who agree to participate receive text messages from Pfizer via Exco InTouch, a UK-based mobile consultancy that says it has provided texting services in more than 20 clinical trials globally. While Pfizer awaits the results, Exco InTouch says its programs reduce follow-up rates (for appointments) by 20% and boost recruitment responses by 500%.Novartis is adding to its Raisin experiment with another wireless adherence program that monitors the medication packaging rather than the patient. Using a special mobile reader called eMedonline, Novartis trial managers are passively monitoring a cancer trial by tracking when medicines are removed from the packaging. The technology used, RFID (radio frequency identification), is well documented; logistics-heavy companies such as WalMart use it to track packages. With eMedonline, when a patient opens packaging to take a pill, an RFID signal is recognized by his or her mobile device and then passed to a central server. eMedonline is the product of an Illinois firm called Leap of Faith Technologies, which says its system has shown adherence rates of 98%.
Futurecasting: As cell phones (and unlimited data plans) become ubiquitous, their effect will be felt across every category, particularly healthcare. It's not hard to imagine pharma replacing today's media-intensive trial recruitment efforts with simple SMS, iPhone, and social media tools. Mobile devices are much more than marketing channels for the clinical trial manager; they are insurance policies delivering immediate, more accurate data. And if the use of cell phones during trials takes root, their presence will certainly grow in the postmarketing setting, making it vital that pharma marketers pay close attention to their recruitment colleagues down the hall. If patient outcomes are truly enhanced by mobile technologies, we may even one day see the oddity of the mobile label: "Drug X is approved to treat diabetes, when used in conjunction with a cell phone."Jeff Greene
Director of Strategic Services