IMS Health's recent report "Engaging Patients Through Social Media" picks up on an oft-heard theme in digital health, and for the first time backs it up with quantitative data. Pharma is behind on its use of social media, compared to other big companies and especially compared to the rest of the healthcare system. Forbes' Dan Munro quotes Howard J. Luks, board member at the Mayo Clinic Center for Social Media in his piece on the IMS data.

"When you look across the healthcare landscape – most of the core leadership at large healthcare institutions are embracing the power of social – the power of pull," Luks says. "Pharma has been the lone and notable exception. But it’s inevitable so it’s encouraging to see the public and very visible indications that it’s changing."

But there are good reasons pharmaceutical companies are hesitant to embrace social media. Paulo Machado, a healthcare consultant whose past credits include marketing and innovation roles at AstraZeneca and Bristol-Meyers Squibb, told MobiHealthNews that at least until final guidelines come out, the risks for pharma in social media simply outweigh the benefits.

"They have to walk a fine line and that's why it takes so long to get anything done or approved through a pharma company," he said. "There's a huge sword of Damocles hanging over their head that if they make the wrong call on something they do, the FDA is going to come out and say 'You were actually promoting your product in a way that's off label' and you get a fine or a cease and desist letter, which is not good at all."

While there are an increasing number of regulated medical apps, pharma has been regulated far longer. Machado points out that public notices and warnings from the FDA about pharma products are regular occurrences, and a very real worry to pharma executives. And when it comes to social media, Machado believes pharma companies just aren't convinced the pay-off is there. He thinks that other healthcare stakeholders have a big advantage on social media, both because they're less limited in what they can say, and because consumers are more inclined to listen to them.

"I think another challenge is the market's going to get flooded by the rest of healthcare when it comes to social engagement and pharma is low on that pecking order in terms of priority. If I'm a consumer do I want to talk to pharma companies or do I want to talk to my doctor? Who am I going to believe more?" he said. "The biggest competitors to pharma are not other pharma companies, it's other healthcare organizations."

Furthermore, as healthcare moves forward into data-driven, outcomes based care, pharma stands to be left behind, unable to adapt its marketing strategy to reflect how doctors are actually using its drugs.

"The big provider companies are putting systems in place with enough intelligence that they'll know the answers, and they'll be going off label all the time," Machado said. "Kaiser [Permanente] may say 'Oh, whatever, take drug X. Drug X's label was this, but based on our data and what we're seeing with user patterns, that's fine, but here's the particular patient who should be using it, and for how long, and what effect it should be having.' So now the label becomes much more refined. The pharma company is aware of that, but it can't do anything about it, because it's not the official label. So the pharma company can't sell the information that 20 oncologists are using that drug for some obscure cancer."

Even worse, if the affected patient group is small enough, it might not be worth it for a pharma company to go back to the FDA and get the label changed, which is an expensive and time-consuming process.

Re-examining Johnson & Johnson's lead

One key takeaway from the IMS study was Johnson & Johnson's dramatic lead over the competition in social media engagement. But there are lingering questions following the report: For instance, whether IMS's social media analysis looked at whether the more engaged companies were actually benefiting from that engagement in terms of sales or some other ROI. Or whether the analysis made a distinction between Johnson & Johnson's pharmaceutical business and other branches of the company such as non-prescription consumer health -- which could help explain the disparity between Johnson & Johnson and its competitors. In fact, the study did not make that distinction, according to IMS Health.

"The index looks at engagement from the company point of view, and is not specific to a particular segment of the company or product/brand," Murray Aitkin, Executive Director of the IMS Institute for Healthcare Informatics, told MobiHealthNews in an email. "It is possible to do that (and we think companies should be looking at their social media activity in a more granular way) but was not within the scope of this research. J&J has a strong consumer health franchise and is clearly active there; however several of the other companies among the Top 50 pharmaceutical companies (based on global sales) also have strong consumer health franchises yet did not score as well on the Engagement Index."

Johnson & Johnson Director of Corporate Social Media Devon Eyer manages some, but not all, of Johnson & Johnson's social media efforts. She said that at least her focus is not on sales at all (although it could certainly still effect sales indirectly).

"Our intent with our social media channels is to show people who we are and what we value as a company," she wrote MobiHealthNews in an email. "We offer news and information, we share stories, we answer questions, and we hear feedback from our fans. In general, we aren’t talking about our products on Corporate social channels. Our content is more about social good, health and wellness, philanthropy, parenting and family, sustainability, our history, etc. And the intent isn’t to sell product. It’s to show up where people want to talk to us and to add to the conversation. High engagement tells us that we are sharing the things our fans want to hear … that our content resonates with them enough to take action by liking, sharing or leaving us a comment."

On the ROI question, IMS responded that it would be a very difficult analysis for a third party to do, especially distinguishing between the effect of different marketing channels.

"We can’t prove that a high score indicates a high ROI (or contribution to ROI)," they wrote, "but we would argue that since social media is how patients increasingly communicate, seek information, exchange views, etc., then companies that actively engage there are more likely to build a positive relationship in support of their commercial interests than those companies that are not at all engaged. At a minimum, you need to know at some level the reach, relevance and relationship you have within social media channels."

Machado agreed, by the way, that some kind of social media presence is still a necessity for pharma. But whether pharma should be making it a goal to become leaders in social media is a question that perhaps needs to be examined more closely, rather than taken as a given.