social media in health care: fda limits liquid morphine

Social Media in Health CareCase Study:

FDA Removing MorphineChristian Sinclair, MD

April 12, 2009

Background

• Morphine liquid at a concentration of 20mg/ml is an essential medication in hospice care

• It is currently ‘unapproved’ but allowed to be manufactured and distributed by the FDA

March 31st

• The FDA issues a memo notifying pharmaceutical manufacturers to stop making and dispensing a variety of opioid products that are unapproved within 90 days.

• Morphine 20mg/ml is included in the list.

• The memo is posted to the website, RSS feeds and fax. (?email?)

Late March 31st

• A nurse who I used to work with and is a Facebook friend posted a status update.

• Notice the times: I did not see this until late on April 1.

April 1st

• FDA memo mentioned by two people I follow (and trust) on Twitter– @doclake– @johnmulder

• Also hits newspapers– Never saw the story in local paper– Or online news feeds

First mention on Twitter

Re-tweeted in one hour

Re-tweeted again in few minutes

April 1st – Late PM

• Sporadic emails to AAHPM/NHPCO likely throughout the day

• Multiple discussions on local levels• FDA memo and unintended consequences

posted to Pallimed around 11pm CST• Hits RSS and Twitter immediately (800+

subscribers)• Email subscriptions go out around 2am

CST 4/2 (800+ add’l subscribers)

April 2nd

• Comments on Pallimed post begin early in the AM and continue thru day

• Commenters encouraged to contact NHPCO and AAHPM leadership

• AAHPM source says emails between orgs did not start really going until April 2nd

April 2nd late PM & 3rd

• NHPCO on 4/2– Announces on Website, ?Email

• AAHPM on 4/3– Issues email alert

• Neither post to Twitter or Facebook at that time

• Announces plan to write joint letter to FDA

April 4th-8th

• Multiple emails between major organizations detailing strategy

• Official letter from orgs to FDA on 4/6

• Individual Letters/Emails to the FDA

• Individual Letters/Emails to Congress

Thursday, April 9th

• A Facebook group protesting the memo is formed the morning before the FDA teleconference

• FDA arranges teleconference• AAHPM gets the word out by email,

Twitter and Facebook only minutes before teleconference (due to late arrangement)

• Multiple listeners on conference call– ?numbers?

Thursday, April 9th - PM

• FDA issues reversal of memo

• Morphine 20mg/ml will not be removed from the market at this time

• Although regional shortages are still present

• Announced by:– Email, Facebook, Twitter, and Websites– By multiple individuals and organizations

Reversal Announced

• On many different platforms– Individual emails– Broadcast emails– Twitter (and re-tweeted a lot)– Facebook (in many different groups)– On websites (AAHPM, NHPCO, FDA)– On blogs (HFA, About.com, Pallimed)

Lessons

• Develop your social networks across platforms for maximum effect– You must contribute to the social network or

else you will not have the connections or social capital to move messages

– Pallimed has built readership over 4 years but has never been part of an event like this

– Our readers felt empowered by a shared narrative. What is your networks shared narrative?

Lessons

• Redundancy is good– If you find something important to you, pass it

on, even if you think your friends & followers may have already heard it

– I missed the FDA memo on Facebook and the News, before I saw it on Twitter

– It is sometimes OK to repeat your message– It is better if other people do it for you

Lessons

• Be humble– I cannot pretend to think posting about the

FDA memo on Pallimed changed the world– But it could have accelerated the change– If the Twitter/Facebook and other social

networks you need are strong, you can move mountains

– Or get the FDA to reverse a ruling in 9 days.

Lessons

• Stickiness Matters– No one will forward what you had for dinner– But if you put your concern in context for your

reader/friend/follower, they will listen, and possibly interact, and possibly pass on your message

Thanks to:

• Drew Rosielle, MD– For creating Pallimed and letting me join

• My Twitter and Facebook networks– For passing on the message because it meant

something to you

• Email any questions/corrections to:

ctsinclair@gmail.com