Jeremy A. Greene

Online Social Networking by Patients with Diabetes: A Qualitative Evaluation of Communication with Facebook

BackgroundSeveral disease-specific information exchanges now exist on Facebook and other online social networking sites. These new sources of knowledge, support, and engagement have become important for patients living with chronic disease, yet the quality and content of the information provided in these digital arenas are poorly understood.ObjectiveTo qualitatively evaluate the content of communication in Facebook communities dedicated to diabetes.DesignWe identified the 15 largest Facebook groups focused on diabetes management. For each group, we downloaded the 15 most recent “wall posts” and the 15 most recent discussion topics from the 10 largest groups.PatientsFour hundred eighty unique users were identified in a series of 690 comments from wall posts and discussion topics.Main MeasuresPosts were abstracted and aggregated into a database. Two investigators evaluated the posts, developed a thematic coding scheme, and applied codes to the data.Key ResultsPatients with diabetes, family members, and their friends use Facebook to share personal clinical information, to request disease-specific guidance and feedback, and to receive emotional support. Approximately two-thirds of posts included unsolicited sharing of diabetes management strategies, over 13% of posts provided specific feedback to information requested by other users, and almost 29% of posts featured an effort by the poster to provide emotional support to others as members of a community. Approximately 27% of posts featured some type of promotional activity, generally presented as testimonials advertising non-FDA approved, “natural” products. Clinically inaccurate recommendations were infrequent, but were usually associated with promotion of a specific product or service. Thirteen percent of posts contained requests for personal information from Facebook participants.ConclusionsFacebook provides a forum for reporting personal experiences, asking questions, and receiving direct feedback for people living with diabetes. However, promotional activity and personal data collection are also common, with no accountability or checks for authenticity.

The Burden of Disease and the Changing Task of Medicine

Disease has changed since 1812. People have different diseases, doctors hold different ideas about those diseases, and diseases carry different meanings in society. To understand the transformations of disease over the past 200 years, one must explore its social nature.

HIDDEN in PLAIN SIGHT Marketing Prescription Drugs to Consumers in the Twentieth Century

Although the public health impact of direct-to-consumer (DTC) pharmaceutical advertising remains a subject of great controversy, such promotion is typically understood as a recent phenomenon permitted only by changes in federal regulation of print and broadcast advertising over the past two decades. But todays omnipresent ads are only the most recent chapter in a longer history of DTC pharmaceutical promotion (including the ghostwriting of popular articles, organization of public-relations events, and implicit advertising of products to consumers) stretching back over the twentieth century. We use trade literature and archival materials to examine the continuity of efforts to promote prescription drugs to consumers and to better grapple with the public health significance of contemporary pharmaceutical marketing practices.

Assessing the Gold Standard — Lessons from the History of RCTs

Randomized, controlled trials have become the gold standard of medical knowledge. Yet their scientific and political history offers lessons about the complexity of medicine and disease and the economic and political forces shaping the production and circulation of knowledge.

Pharmaceutical Marketing and the New Social Media

As communications media have evolved, manufacturers have tended to wait for the FDA to establish explicit codes of acceptable marketing practices before devoting substantial resources to a new medium. Direct-to-consumer advertising in print media proceeded tentatively until the FDA issued a guidance document in 1985 establishing a standard format for providing a “brief summary” of risks. Prescription-drug advertising in broadcast media was similarly minimal until the FDAs guidance revised the definition of “adequate” risk information in 1997, and again in 1999, to permit broadcast media to include references to a toll-free number or Web site where consumers could obtain more detailed descriptions of a products adverse effects. In the wake of these FDA actions, spending on direct-to-consumer advertising mushroomed from

Attention to ‘Details’: Etiquette and the Pharmaceutical Salesman in Postwar American

579 million in 1996 to

Why Do the Same Drugs Look Different? Pills, Trade Dress, and Public Health

1.3 billion in 1998 and to over

Reform, Regulation, and Pharmaceuticals — The Kefauver–Harris Amendments at 50

4 billion in 2008. In November 2009, the FDA convened a public hearing to discuss pharmaceutical promotion through Web-based social media, which present some new challenges.

Why Is There No Generic Insulin? Historical Origins of a Modern Problem

This paper provides a sketch of the emerging role of the pharmaceutical salesman, or ‘detail man’, in the growth years of the American post-World War II pharmaceutical industry. Using training manuals, trade literature, in-house company newsletters, memoirs, and a variety of other published sources, the paper follows the delicate tactics employed by salesmen and their managers in their attempts to recast drug salesmanship as a ‘professional service’ fulfilling vital functions within medical education. As they worked to legitimate their presence in the nation’s hospitals and clinics, particular emphasis was given to precise management of the etiquette of doctor–salesman interaction. Ultimately, the techniques employed by mid-century salesmen and their managers were to prove successful in generating a widespread acceptance of the industry representative within the clinical spaces of hospital and clinic. Indeed, many of the practices of market research and market strategy employed across the pharmaceutical industry today have their origins in the practices of the individual detail man. Exploration of the postwar pharmaceutical salesman as an overlooked historical ‘type’ provides significant insights into the intersection of medicine and the consumer marketplace during the later 20th century.

A Historical Perspective of Pharmaceutical Promotion and Physician Education

In this article, we review the legal basis of trade dress as it has applied to pharmaceutical products and consider the public health implications of variations in pill appearance. We then discuss how a system of more uniform drug appearance could be designed to reduce medical error and promote patient adherence to treatment regimens that involve generic drugs.