This situation has broad implications for all medical specialties, but carries some particular concerns for rheumatology, experts say.
First, advertising via the Internet and social media does not have the same level of control as advertising via print media, television, or radio, where there is a more targeted audience, says Lenore Buckley, MD, professor of internal medicine in the division of rheumatology, allergy, and immunology at Virginia Commonwealth University in Richmond. Dr. Buckley previously served on an FDA advisory committee on arthritis drugs and is a member of the ACR Drug Safety Committee. “The promotions can be disseminated much more quickly to wider audiences, and this is a more difficult media for the FDA to monitor,” she says.
“The target is everything and everyone,” says John J. Cush, MD, director of clinical rheumatology at Baylor Research Institute in Dallas. Dr. Cush has also worked with FDA advisory committees. “You can say you’re going to send something to 1,600 people, but where it goes after that is totally out of your control.” This could make it more difficult to ensure that consumers receive accurate information about drug side effects and other risks. Dr. Buckley gives the example of watching TV commercials several years ago, where drug risk information was spoken “at the speed of light.” Today, due to updated rulings from the FDA, drug risk information is spoken in a slower and clearer manner—all while images of smiling medication users continue to appear on the screen. This odd juxtaposition may help make consumers question the use of that particular medication more, she says.
The question is how to get these potential risks and side effects across via the Internet and social media, where both users’ attention spans and available space are often much smaller than in other venues. There is also the concern of whether messages spread via the Internet can be tampered with, Dr. Buckley says.
A concern specific to rheumatology is size of the drug market. “We are a small group of influential prescribers. Our drugs are often the most prescribed or the most expensive out there,” says Dr. Cush. “What happens if [the situation with Tasigna] were to occur with a biologic? Or a Celebrex?” In other words, it is particularly important that manufacturers and marketers of rheumatologic drugs pay close attention to the FDA’s reaction to the Tasigna website and any similar situations that emerge in the future.
Implications for Physicians
Although any forthcoming FDA guidance regarding Internet and social media advertising will have the most significant impact on pharmaceutical companies, there will likely be implications for physicians. “If doctors are part of the promotional process—for example, physicians serving as experts promoting a treatment in text, audio, or video—then their opinion can reach a younger and wider audience,” Dr. Buckley says.
