Boldly Going Where Many Have Gone Before

When it comes to promotion of marketed products via Web 2.0 and social media, the pharmaceutical and device industries seem compelled (at least until regulatory guidance becomes public) to continue finding their way by trial and error. But the current state of affairs should not dissuade life sciences companies from engaging in one of the most promising and mutually beneficial online marketing activities: leveraging social media networks to drive clinical trial patient recruitment.

Scott Connor

Many trial sponsors have questions about the value and legality of reaching potential participants online. Social networks have already demonstrated the ability to generate targeted numbers of pre-qualified patient referrals as well as lower sponsors' overall cost per randomized patient. And whether recruitment happens online or through more traditional means, it doesn't matter; clinical trial sponsors are neither selling a product nor making promises or claims about treatment. They are simply presenting trials as an option to potential participants. As long as we utilize sponsor- and IRB-approved content, the mechanism should not matter.

As in other enterprises, fortune will favor the bold in this venture into online clinical trial recruitment. Social networks—including MySpace and Facebook as well as increasingly popular sites such as bebo, Hi5, and Ning—have already proven that they have a place in the modern clinical trial recruitment mix. Sponsors who hesitate to utilize them are missing opportunities to proactively and cost-effectively place trial information directly in front of potential participants.

The Power of Networking

Social networking provides a tremendous opportunity for clinical trial sponsors. According to a February 2010 report from the Pew Research Center, 52 percent of adults ages 18–64 now have a profile on at least one social networking site. And since individuals have actively opt-in to social networking services, they are more likely to receive and act upon messages delivered through those media than they to respond to unsolicited communications or even traditional advertising.

Social networking sites also provide the potential for peer-to-peer influence and referrals. The viral aspects of social networking sites and related activities mean that a message's reach can expand exponentially—without the accompanying exponential investment.

Let's be clear though: Social networking is not a trial recruitment panacea. It's highly unlikely that, by itself, a social networking campaign can fulfill the enrollment goal for any clinical study. However, assuming an understanding of the opportunities and limitations associated with social networking and e-recruitment, it can be a valuable part of the clinical trial marketing mix.

Define Audience, Identify Space

While the first foray into e-recruitment can be intimidating for clinical trial sponsors, social networking really isn't so different from other methods of trial recruitment. Establishing visibility in an online environment requires the same basic approach utilized in more traditional recruitment channels: Define and understand the target patient group, then structure a strategy that will motivate them to respond.

Social networking sites are already designed to help sponsors target advertising and content based on the patient population, disease state, and research sites. Facebook and MySpace, for example, have the ability to target advertisements to individual users' pages based on information in user profiles, including gender, birth date, and geographic location.

Given the fact that social networks reach people in nearly every major city in every country on the globe, the ability to target messaging geographically (geo-targeting) is critical, helping ensure the cost- and recruitment-effectiveness of online trial promotion. Both Facebook and MySpace allow advertisers to target messaging within a specific radius of a city or by ZIP code. It's best to stay within 30 miles of the site for most disease categories, as distance to a research site is still, by far, the number one factor in patients' choice to participate in a trial. Trials recruiting for serious indications such as cancer are the exception to this rule. These patients are willing to travel farther for treatment, so sponsors can usually extend the geographic recruitment radius.

Next, develop approved messaging for use in various formats. It's important to develop a full range of discrete messages in the form of online advertisements, canned tweet responses, and text-based hyperlinks. These are the most common formats that social and online health networks use throughout their distribution channels, and sponsors need regulatory approvals for all of them.

But the approval process doesn't stop there. Once a sponsor submits an IRB-approved message or advertisement for inclusion on Facebook or MySpace, an internal editorial committee at the respective social networking service reviews the content. If it's approved by this committee, the ad is displayed within specific sizing and placement parameters on the network. Edits to content must go back through the regulatory, sponsor, and social networking approval loop, but the online nature of the messaging makes this process much faster than editing and re-approving advertisements for traditional media like television.

Disseminate Content in Selected Spaces

Once the target patient is defined and content and messaging are approved, sponsors are ready to begin strategically and systematically introducing the content into selected social networking spaces.

While the list of social networking services with critical mass behind them is always growing, sponsors also have the option to create their own unique, specific applications that run on users' social networking "desktops" (Facebook or MySpace profiles). Advertisers build these applications using publicly available application programming interfaces (APIs) developed and published by respective social networks. APIs enable individual applications to function and behave consistently in terms of installation and dissemination within given networks, including how users share an application with network friends.

Last year, Acurian created and launched "Click It Forward" (CIF), a proprietary initiative and application designed to grow clinical trial awareness online, increase patient access to relevant trials, and increase sponsors' access to interested participants. The initiative invites Facebook and MySpace users to add CIF, a cause-related social marketing application, to their profile pages, in exchange for a donation to a selected health-related cause. Based on the cause or causes that each user selects, Acurian displays specific clinical trial participation opportunities on the CIF dashboard and sends IRB-approved e-mails to users who have provided permission to be contacted.

Monitor Results, Adjust Resources

The on-time, on-budget completion of any clinical trial recruitment effort is always dependent upon the ability to measure, assess, and adjust recruitment tactics in real time. This capability has become even more critical in the current environment, as recruitment budgets shrink and the marketing mix becomes more complex. Sponsors need tracking mechanisms that allow them to immediately identify less effective tactics, and redirect time and money into those that are generating a better return—whether online or not.

The availability of channel-appropriate, effective options should apply to pricing as well. Traditional online promotional pricing is based on cost-per-click or cost-per-thousand impressions. These pricing systems do not protect sponsors from curiosity seekers or geographically inappropriate users who click on trial ads (therefore incurring cost) while never intending to participate in studies. Without a performance-based pricing structure in place, sponsors bear the risk of online advertising that is too broadly disseminated or that attracts too many virtual "tire kickers." Sponsors should look for recruitment partners with the business volume to negotiate payment based on achieving a meaningful recruitment milestone, such as pre-qualified patient referrals that are geographically proximate to a participating research site.

Equally important is the ability to track and measure all sources of e-recruitment in real time. Performance can vary greatly within social networks, and it is imperative that clinical trial teams have the ability to act quickly when managing a recruitment budget. Most major recruitment firms offer platforms that collect and evaluate conversion ratios from dozens of Internet-based sources simultaneously and in real time, and then integrate these data with the results from more traditional recruitment activities. These dashboards enable study teams to evaluate and adjust their strategy in the heat of battle to further ensure that recruitment funds are allocated to top performing campaigns and research sites.

In the face of continued uncertainty around online patient and consumer communications, many clinical trial sponsors have adopted a "wait and see" approach toward e-recruitment. Fortunately, though, there is already enough accumulated e-recruitment experience that sponsors can be assured of its viability. Waiting to venture out into this new world could mean sacrificing time, dollars, and potential participants. In 2009, a full 54 percent of all pre-qualified patient referrals generated by Acurian's recruitment efforts came from online initiatives. And, as individuals increasingly get their news and information online, traditional recruitment channels will continue to fall behind in terms of prominence and value.

With the right approach, the right experience, and the right tools, social networking channels can be cost-effective and efficient recruitment tools that put sponsors' messages in front of selected, active and engaged audiences.

Scott Connor VP of Marketing at Acurian. He can be reached at scott.connor@acurian.com