For the past 25 years, pharmaceutical companies have been permitted to market their products directly to consumers. More recently, in the years following the Food and Drug Administration’s relaxation of direct-to-consumer (DTC) advertising guidelines in 1997, spending on such promotion grew more than six-fold, reaching $5 billion by 2008.
In the traditional media of print and broadcast, those DTC ads come with lots of fine print, including warnings of possible side effects that most consumers. But now that ever-increasing amounts of pharmaceutical marketing have moved online, there is another kind of fine print—the truth about invasive and potentially misleading pharmaceutical advertising—that consumers may never see at all.
The Center for Digital Democracy recently shared these concerns in a formal filing to the FDA, the highlights of which follow:
1. Personal Data Collection and Privacy
Online pharmaceutical and health marketing companies have developed an extensive data collection and interactive targeting apparatus. Few U.S. health consumers are aware that they are being identified, labeled, profiled, and tracked on the Internet while they search or access information on specific conditions or concerns.
2. “Condition” and Behavioral Targeted Advertising
Behavioral targeting enables health marketers to stealthily follow consumers online—sometimes across many different websites—gathering details on their interests and activities, and then offering them marketing messages precisely honed to their behaviors related to an illness or condition. Digital marketers employ online “ad networks” to help track and then target individual consumers seeking health-related information. There are also a number of specialized health portals and networks specifically created to target consumers based on particular conditions or concerns.
It should perhaps come as no surprise that many of the companies whose products are rooted in scientific research have turned to neuroscientific techniques in an effort to influence health consumers’ subconscious decision-making processes. Called “neuromarketing,” such techniques are increasingly employed to research, design, and implement online advertising campaigns—including those for health and medical products. NeuroFocus, for example, a firm that specializes in the application of brainwave research to advertising, programming, and messaging, uses “neurological testing [that] delves down to the subconscious mind,” far below such “corrupting factors” as education, language, and cultural variances. Measuring as many as 64-128 sectors of the brain at 2,000 times per second, NeuroFocus promises results that are “unambiguous, accurate, and actionable”—results, we should add, that are achieved without the consumer’s knowledge or consent.
4. Social Media Monitoring and Marketing
Perhaps most alarmingly, marketers have developed applications that allow companies to eavesdrop and analyze conversations by and among health consumers, taking advantage of users’ networks of friends to orchestrate peer-to-peer brand promotion. These new surveillance tools monitor conversations among social network users to identify what is being said about a particular issue or product. Marketers then work to insert brand-related messages into the social dialogue, often by identifying and targeting individuals considered brand “loyalists” or “influencers,” and encouraging them to generate buzz through their networks of friends. Increasingly, advertisers are using Facebook’s marketing apparatus—which is largely invisible to its users—to develop a brand presence on its pages so companies can strongly connect to the social communications of a very large pool of consumers. Heartbeat Digital’s BuzzScape, for example “allows clients to monitor discussions that flow in and out of the tens of thousands of message boards, forums, blogs and social networks that increasingly dominate the online environment.” As Heartbeat CEO Bill Drummy admits, “In a sense, we eavesdrop on public conversations among people with a shared interest, then use what we learn to create interactive marketing campaigns that address the identified needs, wants and gaps in knowledge of target audiences.” Perhaps the biggest gap in audience knowledge, of course, is awareness of the fact that online conversations concerning the most sensitive health concerns have become just so much grist for the pharmaceutical marketing mills.
5. Unbranded Sites
Another common practice among pharmaceutical companies is the use of online video and websites to raise the awareness of a particular disease or condition—often without clear disclosure of sponsor relationships. Ostensibly designed as educational sites, where individuals can share their experiences with various treatments for certain maladies, sites such as LivingWithEpilepsy.com or ParkinsonsHealth.com are also useful to pharmaceutical companies as a “soft sell” opportunity, free of FDA-mandated risk-disclosure and other advertising requirements.
6. Ad Exchanges
These commercial arrangements allow companies to auction off individual users to specific advertisers in real time for ad targeting. Increasingly, the targeting is accompanied by so-called “data optimization,” which draws on various information resources to compile more complete profiles of individual users. For example, Google/DoubleClick’s Ad Exchange Health focus has 36 categories, from Arthritis and Diabetes to Respiratory Conditions and Sleep Disorders. Another advertising network, ADSDAQ, offers 50 health-related categories, from A.D.D. and Alzheimer’s Disease to Weight Loss and Women’s Health. Again, consumers are never apprised of the way their personal data—including intimate health-related information—is being sold to the highest bidder.
7. Audience Segmentation
The division of consumers into much smaller affinity groups (e.g., Business Travelers, Sports Fans, Technophiles) for the purpose of targeted marketing is a longstanding advertising practice. Its use by pharmaceutical marketers, however, especially in the digital context, raises a number of critical issues. The segments into which pharmaceutical companies divide their audiences go far beyond demographic and lifestyle categories to include highly personal and sensitive information relating to one’s health. For example, as Mark Miller, senior vice president for healthcare marketer Epsilon, explains, “Segment profiling dimensions include (but are not limited to): market size, geo-demographic characteristics, medication usage, self-care behaviors, bio-metrics, insurance coverage/ usage, needs/attitudes/behaviors and media consumption.” The goal of these data collection and analysis efforts, moreover, is to influence consumer behavior in some of the most personal and profound decisions they will ever have to make, concerning their own and their family’s health.
8. Mobile Campaigns
Many of the same consumer data collection, profiling, and behavioral targeting techniques that have raised concerns in the more “traditional” online world have now been brought into the mobile phone marketplace. As U.S. consumers increasingly rely on their mobile devices for a wide range of services, including sensitive transactions related to health, the expansion of behavioral targeting into the mobile world (where it will be combined with precise user and location data) is especially troubling. “Not only does Mobile have a ubiquitous presence—with us 24/7,” boasts Peter Nalen, CEO of Compass Healthcare Communications, “—it can also reach more people, more efficiently, and with greater targetability.” That’s not the kind of personalized service, however, that consumers may want or need in the healthcare arena.
And that’s why CDD has called upon the FDA to remedy this situation, first by conducting a comprehensive investigation into the use and impact of digital health marketing techniques and technologies, and then by working with the Federal Trade Commission and other appropriate agencies to develop a set of policies for regulating the use of behavioral targeting, data collection, and other digital techniques in the marketing of drugs and health-related products.