Direct-to-Consumer 2.0: Try It, You'll Like It

Once you get past the Disney allusion, it's easy to see the appeal of the idea that everyone in the world is linked by a short chain of social acquaintances. This "small-world phenomenon" was first advanced four decades ago by social psychologist Stanley Milgram, whose groundbreaking work includes the theory that there are only six links, or acquaintances, between any two randomly selected Americans. Popularized as "six degrees of separation," this notion has been transformed by the digital revolution into a buzzing, booming hyperreality beyond anything even the radical Milgram could have imagined.

The Impact of Online Info: In a survey of some 3,000 Web users, half said their last health search had an effect, with treatment decisions, overall approaches, and doctor communications the most common

But not beyond anything a marketing expert could dream of. Through consumer-generated content, people who might not otherwise associate are forging meaningful connections—in virtual communities—based on their common knowledge, interests, and goals. These communities, called social networks, are redefining commercial spaces—and classic marketing concepts like "brand as product" and "word of mouth"—with their 24/7 consumer-driven dynamism.

As the Cluetrain Manifesto, the bible of the Internet-marketing movement, puts it: "A powerful global conversation has begun. Through the Internet, people are discovering and inventing new ways to share relevant knowledge with blinding speed. As a direct result, markets are getting smarter—and getting smarter faster than most companies." In healthcare, where well-being and emotion have long been inextricably linked and markets were always based on conversations, these social networks present themselves as pitch-perfect opportunities to build lasting relationships and brand loyalty—and to advance the public health.

The Online Health Experience: The majority of Web users reported feeling empowered by the health info accessed. But about 25 percent said the info left them "overwhelmed" or "frustrated"

Where Baby Boomers and Gen C Meet

Online social networks are the spawn of Internet technology and the rise of a new wave of connected consumers. This "Generation C" shares digital content via blogs and other interactive Web sites, mobile phones, and devices like the BlackBerry. Contrary to popular perception, though, Gen C is not the exclusive domain of idle teens; nearly half of all MySpace.com visitors are 35 and older.

Some history: Social networks first emerged to meet basic communication needs among Web users, but commercial applications quickly became evident. Reader-posted reviews made Amazon.com one of the first profitable interactive communities focused on a shared interest. Friendster.com,Tribe.com, and similar services enabled members to organize their recreational and business activities. Soon they were trading up to the next model of social-networking sites, which were more user-friendly and segmented around specific interests, such as business, politics, culture, and gaming. MySpace.com, which provides access to a network of friends, photos, videos, music, and blogs, is one of the most visited sites on the Web and features more than 100 million individual profiles.

Today, true to Cluetrain form, companies are getting in on the act—creating "branded communities" and increasingly fixing them at the center of the marketing mix. Consider Mini Cooper's club of car owners, which lets Mini enthusiasts post topics, respond to polls, and share photos and other artifacts of their auto ardor. The site boasts a 70-percent participation rate among owners and up to 20,000 unique visits a year. In fact, the Mini community is so organized that it holds real-world car rallies all over the United States every weekend, leading Mini execs to say, "The brand is not the car. It is the entire experience, a lifestyle manifested in the owner's network."

Our Big Fat Blogosphere: The number of blogs, or user-generated Web sites, doubles every six months-a rate even faster than that of the national debt

Soup giant Campbell's flies its own branded-community flag. Started as an online recipe exchange, Campbell's Kitchen (www.campbellskitchen.com) has grown into a full-service social network with thousands of members sharing info on parenting, nutrition, and wellness. Users provided feedback on the company's planned changes to its most popular soup, averting a New Coke–like crisis. An entire library of member recipes was catalogued for marketing with new soups, and activity on the site correlates closely to the rise and fall of soup sales.

A World Wide Web of Health Hunters

Back in the 1990s, a series of online message boards was posted by NBC and Warner Bros. to create buzz about the premiere of a live episode of the then-hit TV series ER. Broadcast execs were struck by the sheer volume of people wanting to talk online. Even more surprising was the discovery that what ER fans clicked on to talk about wasn't so much the show—or even George "Dr. Doug Ross" Clooney—but their own medical problems.

Healthcare is an increasingly popular subject for online users. They want access to information on complex and often emotionally charged issues, as well as an instant pipeline to experts with answers and to other patients who share similar concerns. Every day, eight million American adults look online for health information—the same number who pay bills online, read blogs, or search the Internet for a phone number or address. According to a PEW Internet and American Life Project online health search survey of some 3,000 Web users last year, 70 percent of those looking for answers to health-related questions used search engines. And the Internet is the second-most important medical source, trailing only doctors themselves. (For more on these users, see "The Impact of Online Info," and "The Online Health Experience," above.)

Finding healthcare information online not only gives consumers and caregivers knowledge, confidence, and an outlet for exchange, but also has a significant impact on their own healthcare routine or the way they care for someone else. These facts are why more and more healthcare companies are monitoring the Web on a regular basis.

The implications of the growing healthcare conversation are significant. Social-networking technology is moving knowledge about health, drugs, and disease from the specialist to anyone with access to a computer; accelerating physician education; and enhancing patient literacy. Because the information exchange is no longer confined to medical-education conferences or pre-op visits, drug companies can only benefit from staking a claim in this endlessly expanding dialogue.

In contrast to traditional marketing methods, social-networking technology creates de facto marketers out of consumers. By reaching out to customers online, a company is treating the customer as both source and audience for ideas about its products and services. Through millions of channels, tens of thousands of users drive the brand message, evolve the brand, and tell the brand story as part of their own story.

Unilever developed a social network for Dove that engaged 200,000 women in 22 countries in a dialogue about the definition of real beauty, effectively turning them into brand managers. While TV advertising echoed the same sentiment, the online content was the driving element, and no product information was included. Through community building—not product selling—Dove demonstrated the impact that unconventional marketing can have on a conventional brand. For Dove's customers, the brand was less about soap than about a massive airing of feelings and sharing of thoughts about female beauty. This experience, in turn, drove up sales more than 50 percent.

Social networking is also shifting the balance from traditional institutions to a new kind of influencer. Online, leaders emerge in the process of information sharing, shaping popular opinion. With growing "Web cred," active consumers bring others to the party.

Marketing observers of WebMD.com might marvel at the way the site, in a model of patient empowerment, allows opportunities for ordinary people to have a voice equal to that of medical specialists. On the Autism Blog, for example, a parent called "blessedmomma" frequently shares insights about her child's diagnosis and experience. Such leaders—by the force of their personality, knowledge, and commitment—keep hundreds of other people online.

The age of 24/7 feedback not only offers consumers the chance to exchange info instantly but also provides companies the opportunity for real-time access to data about these interactions. Only a decade ago, this was akin to a healthcare marketer who had the ability to schedule a focus group—assembling thousands of patients from different geographies, with immediate access to unbiased feedback. With social-network technology, pharmaceutical companies can get a faster and better read on their patients—from lifestyle concerns to treatment satisfaction, from unmet needs to ongoing fears and frustrations. Breakthrough innovations on any number of fronts can be made outside the marketing lab, gleaned from everyday conversations with online users.

The Next Big 'Think' in Pharma Marketing

Clearly, the time has arrived for the pharmaceutical industry to begin to cocreate their branding, advertising, and marketing communications with consumers, doctors, and others whose voices are already influencing their brands. But this new territory can be scary for more traditional or heavily regulated industries. The good news is that social networks, like any social system, have their own standards and rules, which can be monitored and moderated on an ongoing basis. There's more control than may be apparent.

Of course, pharma isn't selling just another widget. An awareness of these complexities, together with tight regulation, has long warranted an approach to marketing that is more cautious than in other industries. Even after a decade of direct-to-consumer ads, many pharma marketers remain reluctant to open wide the door of unfettered dialogue due to the specter of perceived off-label promotions and reporting of adverse events. However, a clear, prudent strategy and consultation with legal, regulatory, and compliance experts can mitigate not only these but other risks, such as privacy, product liability, and intellectual property.

To foster a dialogue that reaches credibly beyond the product to advance the public health, some companies are partnering with professional organizations. For example, in an effort to educate physicians on specific diseases and treatments, companies are sponsoring Web sites with continuing- medical-education tools. Pharmas are also cosponsoring sites with patient groups, such as the Multiple Myeloma Research Foundation (www.multiplemyeloma.org) and the Jed Foundation Ulifeline (www.ulifeline.org/main/home.html), a site for the prevention of suicide in college-age kids. More fully functional networks to launch multiparty real-time communication might include, for example, a community for patients with high cholesterol, sponsored by the American Heart Association.

Whether a social-networking site is direct or co-branded, user registration offers the most manageable solution to concerns about standards and control. Having users sign in with a secure name and password (without sharing information that would be deemed private) gives sponsors a chance to enforce a user agreement regarding the site's rules. Technology enables the site to be continuously moderated and swept every 24 hours to enforce standards, remove inappropriate content, and respond to other issues. Given the regulatory requirements, these protocols are essential to every virtual-patient network—starting with the provision that a site can spur or enhance, but never replace, a conversation with their doctor.

Taking Care of Business, E-Style

Consumer-generated content is the fastest-growing segment of the Web—and blogs, message boards, discussion forums, and social networks are sending the conversation off the charts (see "Our Big Fat Blogosphere," above).

Because of this technology, stewards of corporate reputation and brand are beginning to view these conversations as a gold mine. After all, connected consumers (and employees) are talking about a company anyway. And now technology can identify online influencers, monitor their opinions, and track potentially harmful issues. The real risk emerging is the risk of not mining these data, understanding their impact, and engaging influencers in the dialogue as active partners.

This era of engagement marketing is inevitable. Accepting different, even critical, opinions is a necessary method to build trust and create positive bonds with patients. Moreover, the best way to prevent disgruntled people from harming your brand is to engage them. Users may be quick to disappear from sponsored sites and reorganize on others if they feel that the supporting brands are not being trustworthy.

Consider these compelling benefits of social networks for patients, physicians, and employees:

• Increased diagnosis, treatment, and compliance

While many health-info-hungry Web surfers are early adopters, mainstream consumers are also actively looking for online medical education. WebMD.com and other sites that offer consumer-health content and community play a key role in stimulating patient–doctor and patient–patient conversations. In this way, social networks promise to increase early diagnosis and treatment.

The process of launching and maintaining an online community can help drug companies identify critical insights about barriers to treatment. Driving, moderating, measuring, and augmenting conversations about managing disease can shape perceptions of products and treatment options.

The low rate of adherence to meds is a chronic problem, and healthcare communities offer a unique reservoir of advice, support, and other resources to address it. Through blogs, message boards, and other social-networking tools, members can help one another meet this daily responsibility, while sponsors can analyze issues surrounding adherence and initiate interventions to support it.

Social networks provide an ongoing context for knowledge exchange that is more effective than static information. By creating a safe place for a critical mass of people in similar situations to solve problems together, sponsors position themselves as caring partners actively engaged in consumer well-being. As a result, online communities can have a direct effect not only on improving patient care but on building the public trust.

• Enhanced communication, trust, and influence

One of the chief benefits of sponsored social networks is improving the doctor–patient relationship. Companies can use consumer data to help physicians become more adept at responding to patient questions and motivating patients to lead healthier lives.

In case you slept through the past year or two, YouTube.com, the free video-sharing Web site, has taken the digital world by storm. In fact, there are already thousands of recorded surgeries posted, and professional organizations are exploring the potential of a branded YouTube-type site for surgeons. As with consumer communities, these would be monitored and moderated, and users must agree that it in no way subs for hands-on training.

Empowering doctors to be better, more informed practitioners can have measurable brand-building and brand-loyalty benefits, particularly for manufacturers of medical devices. For its annual meeting last September, the American Society for Surgery of the Hand created a MySpace.com page for hand surgeons, a full-service tool for the 1,900 attendees to interact with one another—not to mention the 113 exhibitors and their 807 staff members—before, during, and after the show. An additional bonus of these MySpace.com spots is their capacity to identify thought leaders (the eBay.com power-sellers of the medical community) whose quiet voices exist outside the pages of JAMA and who might otherwise be unheard.

• Greater collaboration and employee satisfaction

According to a recent survey, only one in seven employees worldwide is fully engaged with his job and willing to go the extra mile. This disaffection can be particularly pronounced in sales organizations, where talent is often geographically dispersed and interaction infrequent.

Pharmaceutical companies need only visit the Café Pharma chat rooms (www.cafepharma.com) for a reality check on employee perceptions—for example, on how benefits and promotions effect job satisfaction. Sponsored social networks can improve employee engagement by creating a trusted place for the staff to go to be heard—and where honest dialogue is part of the culture. In contrast to traditional gripe sessions, where bad feelings seem to multiply, properly planned and moderated employee social networks can serve as an early-warning system for disruptive issues and a source of buy-in for corporate change.

Social networks can also play an important role in identifying—and advancing—high-potential employees by offering more frequent connection than, say, the monthly meeting. The fact that online is always "on" allows for ongoing communication and more diverse responses and reflections. Given time, participants who may not drive the agenda at a formal meeting can share their particular expertise and keep a valuable idea moving forward.

Social networks can build company relationships across boundaries of time and geography, breaking down organizational silos. Employees can locate sources of specific information and institutional knowledge that they previously needed organizational charts (and a good treasure map) to find. Access to deeper, more diverse perspectives can empower employees to take responsibility.

E-communities allow employees to engage not only with one another and their managers but also with customers. AppleLink, the Apple computer empire's social network, enables its 14,000 employees to connect with distributors, suppliers, third-party developers, and customers. This brings them closer to all the audiences that influence Apple's success, making them feel more valuable—and invested in not just their own but their company's success.

The evolution of technology, particularly consumer-generated content, has forever shifted the marketing landscape—from impressions to customer evangelism, from brand as a static concept to brand as a living organism. Social networks have the potential to shape the business of pharma perhaps more than any other industry. For these healthcare companies, their brand now lives not just on television, in print ads, and in consumer experiences but in the very voices of the customers, employees, and physicians who influence their success.

Although late to the game, the industry still has time to seize upon this marketing revolution and reap the benefits of growing employee engagement, improved collaboration, nimble product development and innovation, stronger brand loyalty, and deeper public trust.

Lynn O'Connor Vos is the CEO and president of Grey Healthcare Group. She can be reached at vos@ghgroup.comSharon Callahan is the president of Summit Grey. She can be reached at scallahan@summitgrey.com.