On November 12-13, I took part in a Washington D.C., hearing organized by the FDA on how pharmaceutical companies can use the Internet and social media to communicate with consumers. The hearing was a source of excitement in the healthcare industry – the FDA received more than 800 requests for 350 seats.

Over two days, more than 60 speakers – representing pharmaceutical companies, agencies, research firms, search and social media websites along with consumer organizations – shared their thoughts on how companies can responsibly engage consumers online, as well as questions and areas that need clarification from FDA.

Despite the variety of industries and agendas represented, I was surprised by the amount of consistency in the presentations and recommendations. Through the two days of the hearing, a few key themes emerged:

• No one can ignore the explosive power of social media.
  Several speakers shared great data about how often the Internet is used as a source for healthcare information. With patients, caregivers and doctors alike going online for healthcare information, it simply is not an option for pharmaceutical companies to remain separated from this discussion.
• No one company can be expected to monitor the whole of the Internet.
  In our Nielsen BuzzMetrics dataset of health-specific CGM sites, we collected an average of 83,000 messages per day over the past six months. This volume will only continue to grow, and no one can expect to monitor all of it.
• Pharma is ready to listen, but confusion persists.
  Most pharmaceutical companies would like to listen and even respond to consumer feedback online. However, there is confusion among pharmaceutical companies about how and when it is appropriate for them to engage with consumers online, and what responsibilities they have in doing so. This confusion often results in companies holding back on engaging in social media and sometimes even in listening to what their consumers are saying online.
• Adverse events are a red herring.
  Companies that have not done social media listening often have a fear that they will see a high volume of adverse events in online consumer conversation. (And for pharmaceutical companies, there is a requirement that these events are followed up and reported to the FDA.) In fact, the number of adverse events in online discussion is very low and manageable within the reporting systems that pharmaceutical companies already have in place.

This last point was the basis of my testimony at the hearing. In 2008, Nielsen analyzed online healthcare discussion to define the number of adverse events and found that just 4 of 500 messages contain adverse event information, and only 1 of those messages contained all of the criteria that are required for AE reporting.

For me, the key takeaway from the FDA hearing was this: More and more consumers are online looking for information on their health. Some of the information they find online is good, but some is not, and it’s not always easy to tell the difference. Right now anyone can contribute to the online health discussion except the pharmaceutical companies, who are waiting for guidelines from the FDA about how to engage online in an appropriate and responsible way.

There was a sense of hope among attendees at the hearing that the FDA will provide new guidelines on the Internet and social media relatively soon. When that happens, not only do we empower the pharmaceutical companies to interact with consumers online, but we give them a sense of duty to contribute to the conversation in a responsible way. Of course it’s not appropriate for pharmaceutical companies to get involved in every consumer discussion about healthcare online. But where these companies can contribute value to the discussion, let’s empower them to do just that.

Like many of my colleagues in the pharmaceutical/healthcare field, I look forward to watching and participating as the discussion continues to unfold.

• Download a healthcare-focused whitepaper authored by Melissa Davies: Listening to Consumers 101, How Marketers Can Leverage Consumer-Generated Media

Jim Mansfield, Customer Development, The Nielsen Company

Contributors: Melissa Davies, Jennifer Wehringer, Gabrielle Gibbs, Dale Norton, Robert Buckeldee, Meghan Palestis, Mike Hudak and Allison Fitzenreiter

SUMMARY: The U.S. Food & Drug Administration’s warning for the use of acetaminophen sent temporary shock waves across online chat rooms, which resulted in cautious consumers holding back purchases. While levels returned to normal about four weeks post announcement, online discussions continue to be significant. In the age of instant communications, marketers need to stay ahead of the curve with tactics that educate consumers quickly, accurately and proactively.

On June 30, 2009, the U.S. Food & Drug Administration (FDA) issued a recommendation and warning for the use of acetaminophen. Citing concerns of potential overdose and liver injury, the advisory committee recommended lowering the daily recommended dose of acetaminophen. The commonly used pain- and fever-reliever is found in several nonprescription cough and cold remedies as well as prescription products.

Pain business is big business. Nielsen reports an estimated $732M was spent on total media for the pain category (excluding online) for the year ending June 2009, with more than half (56%) allocated to over-the-counter brands and the remainder to prescription products. With the widespread use of the drug and strong media attention, Nielsen analyzed consumer reaction to the announcement and the resulting impact on sales.

Rising concerns
Immediate consumer reaction to the news of the FDA advisory committee meeting drove a noticeable spike in both branded and generic online discussions of acetaminophen, as the chart below indicates. A review of online chatter for June and July shows buzz volume for acetaminophen. Branded discussion was also significant, with the most chatter among the brands that are most recognizable to contain acetaminophen.

However, in the two-week time period following the advisory committee’s meeting, more than half (58%) of generic acetaminophen discussions was centered on risk information, while only one-fifth of branded product’s online chatter discussed health threats.

After three to four weeks following the announcement, consumer online buzz began to return to a level prior to the warning.

Interestingly, the online buzz and market impact generated was not combined with any broader overt advertising campaign. Nielsen reviewed commercials that aired for products within the pain category and did not find ads indicating specific safety messages in response to the FDA recommendation. However, Nielsen did find an increase in the mention of acetaminophen in advertisements in the weeks after the announcement.

A review of TV commercial spots of prominent pain reliever brands revealed that a few brands aired new creatives and modified prior advertisements with both a voice over and/or an “acetaminophen free” message. The changes seen in these advertisements took place the same week and continue through the most recent available period in September 2009.

Buyer beware
Immediately after the FDA warning was announced, sales of the entire pain category began to decline. Four weeks post announcement, Nielsen estimated that units declined approximately 0.5% (about 2.3 million units), but dollars increased 0.3%. The statistical model incorporated the promotion trends over the period, which was believed to cause the increase in dollars.

In the nine weeks following the announcement, sales resumed, with units and dollars up 1.3% and 0.8% respectively. It appears that consumers initially reacted and paused purchasing any pain product, but as they became more educated of the risks, purchases resumed (approximately five weeks after the warning). As a reference, the average consumers purchase cycle for pain remedies is approximately 50 days, which is within this analysis period.

To determine the predicted dollar and unit sales impact on the pain category, Nielsen employed a statistical method (multiple linear regression) to account for the multiple market levers that were occurring, which included promoted dollars, percent of promoted dollars, total promotion expenditures, online buzz, and gross rating points.

The analysis showed that some brands were more impacted than others. Two directional themes emerged that manufacturers and retailers should consider as the acetaminophen recommendations evolve. First, the brands and store brand products with the most affiliation with acetaminophen were the most impacted by the warning. Second, some brands with dosage instructions that require the consumer to take fewer pills per day appeared to grow.

Feeling the pain
Were consumers who suffer from pain more “tuned-in” to the news surrounding the FDA recommendation? Nielsen analyzed the reach of broadcast and cable programming among ailment suffers who treat their conditions with either a combination of prescription and non-prescription remedies or just non-prescription remedies—in June prior to the acetaminophen announcement and post-announcement in July.

Seven ailment conditions that are treatable with medications that contain acetaminophen were analyzed: Allergies, Osteoarthritis, Rheumatoid Arthritis, Migraines, Chronic Tension headaches, Joint/Neck/Back pain, and Muscle Pain/Spasms.

Both broadcast and cable reached Adults 18–69 during this time period with a 96.75% reach in June and a 95.43% reach in July. However, across Adult (18–69) ailment sufferers whose conditions can be treated with acetaminophen, reach was slightly higher both before and after the announcement at the end of June. Perhaps the segment of sufferers with ailments that cause pain have an increased media reach due to the elevated awareness of the acetaminophen warnings.

Global implications
Global manufacturers and retailers of acetaminophen should take note as countries outside of the U.S. review the use and dosage recommendation of acetaminophen. As it turns out, there are unique differences with regards to how consumers in different countries ensure the appropriate use of non-prescription medications.

A March 2009 Nielsen study revealed that close to half of all U.S. respondents (48%) said they ensure the proper use of non-prescription medications by reading the instructions on the pack. Only 15% said they refer to the product leaflet in the pack, and 12% consult with their pharmacist. These results compare starkly with consumers in Europe, for example, where (on average across 22 countries) fully one-third (32%) of consumers ensure responsible usage by referring to the product information leaflet in the pack, one-fourth (26%) through a dialogue with their pharmacist and only 16% from reading instructions on the pack.

These findings underscore the importance of understanding regional nuances when marketing in a global landscape. Strategies and tactics must reflect these differences to ensure optimal engagement with consumers and proper education on the benefits and safety of acetaminophen.

Cautious consumers
While the initial consumer reaction to the recommendation caused an increase of consumer generated media (online buzz) and decreases in the purchasing of over-the-counter pain products, these trends were later reversed. However, the consumer reaction to “back to normal” should be cautioned. Although consumers believe acetaminophen products are safe, they did show a strong reaction to a call for caution.

The Internet has enabled instant communication where word travels far, wide and deep. As made apparent with the acetaminophen warning, consumers readily seek out information—even without an overt advertising campaign to support it. Manufacturers and retailers have a responsibility—and an opportunity—to properly educate consumers and healthcare providers (pharmacists, physicians, etc.) via multiple media channels and product packaging that is most appropriate for the target audience.

Insights for manufacturers, retailers, and industry groups
The acetaminophen warning, albeit brief, affected the entire over-the-counter pain category. While consumers did return back to the category quickly, the same rebound may have not occurred as rapidly if the discussion of warnings and risks continued for an extended period of time.

In advance of future acetaminophen recommendations, Manufacturers, retailers and industry groups should consider the development of a consortium-like educational initiative about the safety of over-the-counter pain medications for consumers, pharmacists, physicians, and other healthcare providers. An educated healthcare system will be more engaged to repurchase the pain category vs. one that is less understood.

The 2009 flu season is fast approaching (or has already arrived) and this year, swine flu is expected to figure prominently, but online consumers aren’t yet paying attention.

In fact, online discussions about the swine flu have held relatively steady since a spike in April, when federal and world health officials first warned of the spread of H1N1 or “swine flu.” Even now, amid news that 97% of early September’s flu cases were related to the H1N1 virus and as recommendations roll out about swine flu vaccines, Internet buzz a about the phenomenon remains at less than .5% of all online discussions, down from a peak of 2.5% of all buzz in April, according to Nielsen’s BuzzMetrics service.

The U.S Centers for Disease Control’s weekly FluView report (http://www.cdc.gov/flu/weekly/) notes that more than 90% of flu cases currently being reported are H1N1 cases, though the total H1N1 diagnoses per week has dropped over the past two months. The 2009-10 flu season officially begins Oct. 4.

Slight increases in Internet discussion occurred in late August and early September, fueled by flu outbreaks on college campuses and in schools, warnings about possible business absenteeism this flu season, and ongoing news about the swine flu vaccine – including continued tests of the vaccine, news about vaccine availability and production rate, and even by skepticism about safety of the vaccine and confusion about vaccine recommendations for children.

“We saw really significant volume of discussion about H1N1 after the first alerts were issued in April, and although buzz is relatively low now, I expect that we will continue to see the discussion pick up over the next several weeks,” says Melissa Davies, research director of Nielsen’s healthcare practice. “We may see a convergence of events driving this – with school back in session, the start of traditional flu season, and the H1N1 vaccine becoming available later this fall, people will be hungry for good information about swine flu and how to keep themselves and their families safe.”

A scouring of blogs and message boards across Australia found that Aussies were surprised how much they enjoyed New Zealand, particularly its scenery and adventure activities.  And despite a few gripes about insects and gentle mocking of Kiwis’ “eccents,” Australians have taken to New Zealand with gusto.

“This goes to show that despite the traditional ribbing of New Zealand by Australians, they’re coming around to what we have to offer as a destination.  We seem to be winning in the all-important category of word-of-mouth advertising,” said Tony Boyte, research director for Nielsen’s New Zealand online division.

Queenstown was by far the most talked-about tourist destination among Australian bloggers, followed by Milford Sound and Fiordland.  Skiing and snowboarding were the most popular activities in terms of blogs and message boards, followed by surfing and windsurfing, hiking, visiting wineries and bungee jumping.

Earlier this year, Tropicana – the leading juice brand in the U.S. – undertook a rebranding of its ubiquitous packaging.  Gone was the graphic of an orange with a straw in it, a clear symbol that the juice inside the carton was fresh, and in was a more abstract graphic of a glass of OJ.  No doubt, Tropicana took all of the traditional steps for testing the new packaging and rolled it out across the nation.  But consumers who saw the new packaging in stores reacted strongly: they didn’t like it.  And they weren’t shy about contacting the company or posting comments about it on the Internet.

Tropicana quickly relented and reverted to the previous packaging.  A senior executive said, “What we didn’t get was the passion this very loyal, small group of consumers have.  That didn’t come out in the research.”  Tropicana listened to what its customers were saying and shifted course.

This is but one example of how companies are increasingly learning more about their customers by tuning into unprompted consumer expression, or “listening.”  In an age where delivering what your customers want is more important than ever, companies in a range of industries are pairing listening with more traditional forms of research that are based on asking.

Read more about the importance of listening and how it can be used effectively in the latest edition of Consumer Insight.

In the U.S., consumers remain skittish.  Shifts to private label brands continued at a strong pace, as they have for the last eight months, while consumers are shopping less frequently and spending less per trip.  Canadians, on the other hand, are spending more per trip, and are taking advantage of retail promotions.  Unlike in the U.S., private label brands are struggling to gain share as national brands step up promotional activity.

In Europe, the French remain relatively unchanged in their shopping.  Value channels continued to see growth and more retailers were selling on promotion, leading to a modest increase in the amount spent per trip.  Germans showed very little change in the number of shopping trips they took, nor did they increase or decrease how much they spent.  Unit sales increased, however.  In the UK, sales volume improved slightly from the previous month, while budget store brands’ growth slowed as consumers began returning to premium brands.  British shoppers were also spending slightly more per trip.  Italians continued to move to store brands and value channels, although they were reducing their shopping frequency.  Spaniards, who have been among the most optimistic, have not seen that reflected in spending.

Brazilians showed an 8 point surge in optimism, and this translated into more frequent shopping trips and higher sales, in both volume and value terms.  Hong Kong and China both showed growth in sales, but Taiwan showed declines, and optimism there was among the lowest in Asia.  Indian consumers’ confidence was high, and volume and value sales both increased by more than 5 percent.

“While things are starting to look up, it’s clear that Americans and Western Europeans aren’t quite convinced that recovery has taken hold and remain cautious when it comes to shopping.  The labor market is clearly affecting this behavior.  It comes as little surprise that Brazil, India and China – countries that have generally been less affected by the global recession – are among the first to see renewed consumer confidence and sales growth,” said James Russo, Vice President, Global Consumer Insights at The Nielsen Company.

The Buzz

While the idea of recovery hasn’t opened up global consumers’ wallets quite yet, it has started to infiltrate their discussions on the Web.  In June, 71 percent of survey respondents thought that their countries were in recession, an improvement from the 77 percent who thought the same in April.  Additionally, 26 percent believed that their country will be out of a recession in the next twelve months, up three points from April.  Global recession buzz has declined 27 percent since March.  In July, however recessionary buzz perked up, primarily in Western Europe.

“We are likely to see an overall downward trend in recession discussions, but it will be choppy until consumers really feel as if they are experiencing the recovery,” said Russo.

Download the latest Nielsen Economic Current.

On July 22nd, when Rubin first reported that Mets VP of Player Personnel Tony Bernazard challenged players on the team’s minor league affiliate to a fight, the NY Daily News received no spike in online chatter according to Nielsen Buzzmetrics.

But during a July 27th press conference announcing the dismissal of Bernazard, Minaya poured fuel on the fire, by accusing reporter Adam Rubin (in attendance) of writing in self-motivation to get Bernazard’s job. The blogs began to boil, and buzz surrounding the Daily News doubled.

On television, national sports channels and local stations in New York ran with the story. According to Nielsen’s Grabix, which tracks over the air audio mentions correlated with minute by minute viewership data; the Daily News was referenced 24 times delivering a total of 41.9 Gross Rating Points (GRPs) in the New York Market on 7/27 — or roughly 3.6 million Gross Household viewers in New York.*

With dollars tight in a down economy and a transforming print industry, bloggers, word of mouth, and news coverage provided organic, free advertising. For the Daily News, the work of one reporter and a memorable press conference brought their paper to the top of the sports news cycle for at least one day.

*The same viewer exposed to multiple programs that mentioned the “Daily News” is counted each time.

While it’s great news and great fun for the happy couple, the video also seems to have had a halo effect for troubled singer Chris Brown, whose February assault on then girlfriend Rihanna cloaked the singer in months of negative buzz. (Brown plead guilty and received five years probation and must serve 180 hours of community labor.) The wedding video now has a direct link to buy “Forever,” which, despite being released last year, is now in the iTunes top 10. According to Soundscan “Forever” digital downloads went from under 3,000 (week ending 7/19) to 50,000 (week ending 7/26) and sales of Brown’s album “Exclusive” are up %130 in the last week.

Brown’s own attempt at a viral video, a recently released apology video for the Rihanna “incident” which he calls “inexcusable,” has been viewed more than 2 million times. As BlogPulse shows, July buzz about Brown and “Forever” reach almost as high as blog discussion that occurred around the time of the assault.

Vampire-related sites are drawing audiences on the Web. In June 2009, the official Twilight movie site was the top online vampire-related destination, garnering 553,000 unique visitors who spent an average of two minutes and 45 seconds on the site during the month (the New Moon trailer is a minute and 47 seconds long). Vampire Wars on Facebook and Vampire Wars on Myspace.com ranked No. 2 and No. 3, with 386,000 and 272,000 unique visitors, respectively.

Interestingly, unique visitors to Twilight over-indexed among people between the ages of 25 and 34, despite originally sold as a book series for young adults. Unique visitors 25-34 were nearly twice as likely as the average Web user to visit the site in June. Women are also 44 percent more likely than the average Web users to visit the site.

Advertising for True Blood Steps Outside the Box

When HBO geared up for the second season premiere of True Blood, they hired Digital Kitchen to create an interesting ad campaign that would top the campaign for season one. Digital Kitchen enlisted the help of at least six major brands, from Harley-Davidson to Gillette, to create mock brand ads targeted to vampires. In advance of the new season, HBO increased their online image-based advertising for the show by almost 5,000 month-over-month, displaying 72.3 million online image-based ads in June 2009.

Did all of the advertising create the fervor that HBO was after? While buzz on Twilight eclipsed online discussions surrounding True Blood, there was a surge of conversation after the season two premiere. The number of online mentions nearly tripled the day of the premiere, increasing from .03 percent of all online conversations on the 13th to .07 percent on the 14th, which in turn also helped HBO buzz to increase during the days surrounding the launch of season two.

True Blood Helps Draw Online Video Viewers to HBO’s Site

With the second season premiere of True Blood on June 14, HBO experienced double digit growth month-over-month in unique viewers of video online, total video streams viewed, and time spent viewing video online. Total video streams viewed on HBO increased 299 percent, growing from 1.6 million streams in May 2009 to 6.4 million in June. Unique viewers of video increased 101 percent, while time spent viewing online increased 182 percent month-over-month.

While Twilight and True Blood have sparked a surge in interest around vampires, this is not a new phenomenon, but actually just a renewal of interest in these dark characters. Vampires have been a popular subject of fear and intrigue, from Bram Stoker’s Dracula, to Anne Rice’s Interview with a Vampire, to today’s Edward Cullen of Twilight. While the subject is the same, the avenues for connecting with other fans and staying up to date on what’s new are evolving. While you may have discussed Brad Pitt’s character in Interview over coffee with a friend 15 years ago, today you would share you love of last night’s True Blood episode with friends via Facebook.