Jim Mansfield, Customer Development, The Nielsen Company
Contributors: Todd Hale, Tom Pirovano, Heather Grantham, Tony Gleicher, Melissa Herrel, Melissa Conner, Kelly Melanitis, Liz Yurkevicz, Dale Norton, Melissa Davies and Robert Buckeldee

SUMMARY: Consumers worldwide are plagued with the new H1N1 influenza according to the World Health Organization. The H1N1 influenza (swine flu) has a higher rate of infection and has caused the flu season to begin earlier than prior years. Fearful consumers raced to understand how to protect themselves online and also purchase preventative products. The increased rates of infection have caused spikes and declines in selected categories.

In April 2009, confirmed reports from the U.S. Centers for Disease Control revealed a new strain of the flu virus—known as H1N1 (swine flu). By June 2009, the World Health Organization declared a global pandemic alert as more than 70 countries worldwide were infected. By the first week of November 2009, most developed countries reported widespread infection.

Viral reaction
The rapid transmission of the virus translated into swift consumer reaction. Consumers reacted immediately and took the quickest and most readily-available route to information—the Internet. The first online conversations about swine flu took off with over 500,000 messages posted in April 2009 when initial news of the first diagnoses spread. Although, there is a continued upward trend in online swine flu conversation today, the volume has declined five-fold to just over 100,000 messages in November.

While initial Twitter discussions were a bit slower on the conversation uptake than prominent discussions boards like WebMD and iVillage, Twitter discussions remained elevated for several weeks after chatter among forums dropped off significantly after the first week. Twitter actually remained the top source for discussion of swine flu through the summer and into the start of flu season.

Today, as the flu season is back in full swing, the volume of swine flu buzz on discussion boards, blogs and forums is just now moving ahead of Twitter volume again. The fact that Twitter is just one source and there are thousands of online discussion boards validates the impact and intensity of Twitter followers.

Healthy response
Concerned and infected U.S. consumers stocked up on preventative, treatment and sanitizing products at an increased rate. Sales of hand sanitizers in particular increased significantly in April 2009 and then again in October, corresponding to the height of online chatter. From September to October 2009, consumers increased spending per trip on the category 181% compared to the same time period in 2008 and the percent of households buying hand sanitizing products increased 132%.

Similarly, consumers increased purchases in categories that offered a treatment or prevention benefit. Thermometers, vitamins, cough and cold remedies, orange juice, cleaning products, tea and soup all reported year-over-year increases. Spending on thermometers and cough and cold remedies increased 88% and 10% respectively from September to October 2009 vs. 2008 and the penetration for thermometers increased 80%. Overall, more consumers spent more per trip and purchased more frequently compared to last year. Essentially, a household with a child infected with H1N1 spent on average of $23 if they purchased a cold remedy, thermometer, and hand sanitizer—an increase of 6% vs. prior year.

Conversely, it appears that references to “swine” negatively impacted sales of pork products as the category reported a 6% decline in dollars, equating to approximately $930,000, in October 2009 compared to last year.

Meeting demand
While it appears that sufficient quantities of cough and cold products are available at retail, there is a growing concern that the expanded flu season could bring about shortages. To stay ahead of the curve, Nielsen developed a forecast demand distribution model to help manufacturers appropriately distribute products to meet consumer demand. An analysis of the U.S. cough and cold category is illustrated as an approach to plan ahead to meet demand.

To understand and isolate the true impact of H1N1, growth in the cough and cold category was decomposed to account for concurrent market events, as significant consumer promotion is occurring in parallel. Nielsen reports $772M was spent on media promotion for over-the-counter cough cold products in the year ending September 2009 and one-fifth of products were sold on promotion.

The sales impact on the cough and cold category was determined by using a statistical method (multiple linear regression model) of 160 weeks ending 10/31/2009 including promoted dollars, percent of promoted dollars, total promotion expenditures, and estimated average influenza like illness (ILI source CDC) if H1N1 did not occur. Historical, influenza rates are available from the CDC and were analyzed from 1999 to date.

Nielsen determined that the introduction of the H1N1 flu virus boosted cough and cold category units by 14% and increased dollars by 4% from week ending September 5, 2009. In the most recent four weeks ending 10/31/2009, units and dollars are up 21% and 1% respectively. The variance in dollars to units is due to the ongoing promotion occurring in the market. Essentially, the approach can forecast anticipated influenza rates for H1N1 and seasonal flu to determine the impact to units and dollars by taking into account all promotion activities. Additionally, ongoing analysis that factors in the significant media outreach and resulting consumer reaction is vital.

Weather the storm
Historically, the flu season peaks from December to January. When comparing current Centers for Disease Control influenza-like illness rates to historic trends, the U.S. is now currently reaching or has already reached a peak. Since most of the flu activity reported to date is for the H1N1 flu, it is likely that the regular seasonal flu (which is still on the horizon) will prolong these trends through February or March 2010, when the seasonal flu typically begins to decrease. Retailers and manufacturers can better anticipate and meet peaks in demand by understanding potential infection rates. And now is the time to take advantage of sales opportunities to partner with other manufacturers with combined offers. With heightened consumer awareness, many will race to purchase preventative, diagnostic and treatment products at the first sign of a sniffle.

The Pew Internet & American Life Project today released the results of its latest survey into how and when Americans use the Internet to gather health information. In The Social Life of Health Information, Pew reports that Americans are turning to an increasingly broader array of online and offline resources in their search for health information.

Highlights from the report include:

• 83 percent of online adults have looked on the Web for health information. (Since 2002, Pew Internet Project surveys have consistently found that 75-83 percent of Internet users look online for health information.)
• Half of online health inquiries are done on behalf of someone else, such as a family member or friend.
• 57 percent of e-patients say that their most recent online health inquiry had an impact on their own healthcare or the way they care for someone else.
• 60 percent of e-patients say they or someone they know has been helped by following medical advice or health information found on the Internet (a significant increase from 31 percent in 2006).

This survey also finds that the Internet does not replace healthcare professionals — a finding that echoes results of Nielsen’s 2008 study into the online and offline resources that people use as part of the healthcare decision-making process. Instead, e-patients take the health information they find online and use it to inform their offline conversations with healthcare professionals, family and friends.

As is always the case, Pew Internet Project’s latest report is a fascinating look at our online behavior, and I am looking forward to the chance to dive further into the data.

The FDA announced yesterday that it is launching a Transparency Task Force, charged with “making useful and understandable information about FDA activities and decision-making more readily available to the public in a timely manner and in a user-friendly format.” The task force will seek public input on how the FDA can be more transparent, including identifying “new technologies for informing the public.” To this end, there will be a public meeting on June 24, 2009, to solicit recommendations.

The FDA created a Transparency Blog to provide updates on the task force’s activities. Though they will be moderated, comments will be allowed on the new blog, and there are parameters around what will be posted (they are reasonable parameters that don’t appear to limit the scope of discussion). Although the FDA recently tipped its hat to Web 2.0, certainly there is much for the agency to learn about social media and all of the communications opportunities it represents.

In the category of government agencies setting a good example of transparency, we have already witnessed the CDC’s use of multiple social media tools to share information with the public during the swine flu crisis earlier this year. Twitter, YouTube and the CDC’s own Web site were all part of the agency’s outreach efforts and helped the CDC provide a calm voice of reason as public fears mounted.

Will the FDA follow the CDC’s lead and begin to leverage social media to make itself more transparent to the public? Taking it a step further, will the lessons learned through this process lead to more definitive guidance on how pharmaceutical companies can and should engage in social media? We look forward to finding out.

My colleague Pete Blackshaw recently hosted a conference call through Nielsen Online’s Social Media and Advocacy Round Table, focused on how brands can leverage the power of consumers’ contributions to the online community. In the call, Scott Wilder, Small Business Online Communities manager for software publisher Intuit, described listening to customer feedback through Intuit’s call center and realizing that customers thought their problems were unique, and that they felt alone in trying to deal with these problems. The solution: Intuit created an online community to help users connect to one another. The company then took it a step further, tapping individuals from the community as “credentialed authors” who can serve as discussion moderators within their areas of expertise.

How is this relevant to healthcare? We know from our Buzz research that patients — like Intuit’s customers — often feel alone with their condition, and come online looking to connect with others “like me.” The online community already is home to influential patients in many different disease categories who are highly informed about their condition, experienced with different treatment options and respected within their communities. When these influencers share their personal experiences with different medications, their online peers listen. Could there be a credentialed role for some of these influential patients, like the model of Intuit’s online customer community?

Case study: In GSK’s alli discussion forums, weight loss experts with different areas of expertise serve as community moderators. According to the site, the moderators are “compensated for their time but the opinions are their own.” GSK is very direct with visitors to the forum that “what you and we can say about alli and how to use it is restricted by Federal laws and regulations,” meaning that comments must be reviewed before they are posted and that some information shared on the site will need to be reported to the FDA.

I fully recognize that OTC is a different world from prescription treatments, so alli does not face the same types of restrictions that many other brands will. But consider this: In EyeonFDA’s recent interview with Dr. Jean Ah Kang of the FDA/DDMAC about pharmas and Web 2.0 (see my earlier blog post on this topic), Dr. Kang notes that a pharmaceutical company might enlist a consumer to act on behalf of the brand to communicate information within the online community. A brief mention, yes, but it’s not off the radar for the FDA.

Has the time come for pharma companies to bring some of these influential individuals into the fold? There will be challenges, to be sure. And, as Intuit’s Scott Wilder noted, one size does not fit all — it will take some experimentation to find the best solution for any company and its customers. But, as Wilder also noted, the benefits in engaging customers and providing the answers and information they need can be well worth the investment.

Last week brought an exciting new development for pharmaceutical companies interested in social media: blogger Mark Senak (EyeonFDA.com) posted an interview with an official from the FDA/Division for Drug Marketing, Advertising and Communications (DDMAC) about pharmas and Web 2.0. Until now, there has been so little mention of social media and the like from the FDA that many pharma companies have come to assume that Web 2.0 is strictly off-limits. The conversation that was started this week — though by no means the final word on whether and how pharmas can engage in social media — is a good starting point to help change that perception.

The big takeaway: The FDA does not prohibit pharmaceutical companies from engaging in social media. This is sure to bring a sigh of relief from brand managers who have wanted to take advantage of Web 2.0 but have been afraid of getting shot down by the FDA or by their own legal teams, who have understandably been very conservative on the issue in the absence of clear guidelines from the FDA. The important thing for pharmas to remember is fair balance in all communications, according to Dr. Jean Ah Kang, Special Assistant to Tom Abrams at DDMAC in charge of Web 2.0 policy development; like in other communications, information about a drug’s efficacy must be balanced with information on its risks.

The FDA won’t yet share its thinking on a process for further defining how pharmas should interact with the social media environment, other than to “recognize that this medium is here to stay.” I have had several conversations recently with clients who are ready to move beyond social media listening and are wondering how they can engage in the environment. Could the FDA’s simple acknowledgment be enough to open the door to a world of change and opportunity for pharmaceutical companies? We will be watching to see.

Several of our staff have touched on the economy in recent days. As consumers’ healthcare costs continue to climb, it seems natural that healthcare cannot be immune to the effects of the downturn that has our world reeling. The New York Times on Tuesday published an article about a trend in patients stopping certain medications because they can’t afford them. Other news sources have reported on various patient cost-saving measures, from splitting pills in half to taking a medication every other day instead of every day.

I wondered if we would see evidence of this trend in our own data. Actually, I assumed we would and wondered just how prominent this topic would be in the online discussion we measure. There is definitely discussion of medication and affordability taking place within the blogosphere, with entry titles like “One Pill Left” and “I cannot afford to get sick” and the simple, direct “uggh.”

But what surprised me in looking at the broader trend of this discussion is that there has not been much of an increase in these messages over the past six months, as our BlogPulse data show:

There is a general upward trend in discussion of medication affordability, but it isn’t the steep climb I expected to see – aside from a noticeable peak in discussion during the week ending September 27 (which was the same week that the Dow experienced a 5% drop for the week and President Bush gave a primetime TV address to present his case for his $700 billion economic bailout plan).

To test the theory further, I compared two different sets of results: one that focuses on messages about not being able to afford medication, and another that uses the same search terms but excludes political discussion in the form of any mentions of McCain, Obama, election, politics, the economic bailout, the Medicare gap, etc. Still, the trend holds: the increase in blog posts about medication affordability is slight, not steep, despite the impact of recent changes in the economy.

It may be the case that people are just overwhelmed by concerns about the economy, to the extent that many aren’t talking specifics yet. Blogosphere discussion of “economy” significantly outweighs “healthcare,” as the following data show:

Will the days ahead bring a shift in discussion, with more mentions of medication affordability or specific steps patients take to manage their personal health and economic situation? Only time will tell, but it’s a trend worth watching.

The Pew Internet & American Life Project today released the results of its latest survey into how and when Americans use the Internet to gather health information. In The Social Life of Health Information, Pew reports that Americans are turning to an increasingly broader array of online and offline resources in their search for health information.

Highlights from the report include:

• 83 percent of online adults have looked on the Web for health information. (Since 2002, Pew Internet Project surveys have consistently found that 75-83 percent of Internet users look online for health information.)
• Half of online health inquiries are done on behalf of someone else, such as a family member or friend.
• 57 percent of e-patients say that their most recent online health inquiry had an impact on their own healthcare or the way they care for someone else.
• 60 percent of e-patients say they or someone they know has been helped by following medical advice or health information found on the Internet (a significant increase from 31 percent in 2006).

This survey also finds that the Internet does not replace healthcare professionals — a finding that echoes results of Nielsen’s 2008 study into the online and offline resources that people use as part of the healthcare decision-making process. Instead, e-patients take the health information they find online and use it to inform their offline conversations with healthcare professionals, family and friends.

As is always the case, Pew Internet Project’s latest report is a fascinating look at our online behavior, and I am looking forward to the chance to dive further into the data.

In the category of letting the customer tell you what the customer needs, Dell this week launched its new IdeaStorm for Healthcare and Life Sciences, an online community where users can share their best ideas for how technology can help improve the field of healthcare. Visitors to the site can vote on others’ ideas, bringing the best ones to the top for possible action by Dell. The idea list is sortable by most recent ideas, most popular ideas, and “Ideas in Action” that are being implemented as a result of IdeaStorm.