Health smartees 2010

2010 HEALTH SMARTEES 2010, June 17 WELCOME @ InSites Consulting Taking Health Research Forward

2010 09.00 – 09.30 : Breakfast 09.30 – 09.35 : Welcome @ our 2010 Health SMARTEES The agenda of the day Saartje Van den Branden, Research Manager Health, InSites Consulting 09.35 – 10.30 : How to engage in the conversation with empowered patients? SCOOP! Results of the Global Health Study 2010 Magali Geens, Research Director Health, InSites Consulting Including latest search data by Google Healthcare by Julia Loncar, Industry Manager, Google Healthcare (EXCUSED – No permit to travel) 10.30 – 11.00 : Coffee Break 11.00 – 11.30 : Using Social Media Nethnography in Health Research Tapping into conversations of connected patients and caregivers Prof. Dr. Niels Schillewaert, Managing Partner, Head of the InSites’ ForwaR&D Lab 11.30 – 11.40: And what about Nethnography on HCP data? Tapping into HCP conversations for Nethnographic analyses Magali Geens, Research Director Health, InSites Consulting 11.40 – 12.05 : Traditional online HCP research: a real-life case An AstraZeneca prescription and forecasting study Sarah Mertens, Customer Insight Director, Intern. Marketing Organisation, AstraZeneca Carl Vandeloo, Research Manager Health, InSites Consulting © InSites Consulting 12.05 – 12.20 : QUESTIONS before drinks & sandwiches Health Study 2010 | How to engage in the conversation with empowered patients | © InSites Consulting, 2010. 2

2010 Global Health Study 2010 How to engage in the conversation with empowered patients? Magali Geens Research Director Health, InSites Consulting Carl Vandeloo Research Manager Health, InSites Consulting June 2010

Philosophy Conversation Advertising Brand

Philosophy Conversation Activation Brand

Health has many stakeholders and because of different factors, a sole focus on the HCP becomes intolerable in the future © InSites Consulting Health Study 2010 | How to engage in the conversation with empowered patients | © InSites Consulting, 2010. 7

Part of the focus should shift towards patients as they are stepping forward and entering the conversation about their health © InSites Consulting Health Study 2010 | How to engage in the conversation with empowered patients | © InSites Consulting, 2010. 8

How can we activate this empowered patient? © InSites Consulting Health Study 2010 | How to engage in the conversation with empowered patients | © InSites Consulting, 2010. 9

2010 Health Study 2010 STUDY in 14 COUNTRIES WORLDWIDE Summary: 5.777 consumers (18+), representative total country population. Data collected on proprietary research panels from InSites Consulting, field in April 2010. . © InSites Consulting Health Study 2010 | How to engage in the conversation with empowered patients | © InSites Consulting, 2010. 10

2010 Edition – Global 2010 How to engage in the conversation with empowered patients? 1 The internet: an important source for today's patients. 2 Connected patients ARE conversating! 3 How can the industry activate the empowered patient? © InSites Consulting Health Study 2010 | How to engage in the conversation with empowered patients | © InSites Consulting, 2010. 11

2010 1 The internet: an important source for today's patients. 2 Connected patients ARE conversating! 3 How can the industry activate the empowered patient? © InSites Consulting Health Study 2010 | How to engage in the conversation with empowered patients | © InSites Consulting, 2010. 12

2009 The patient action flow – Health Study 2009 Q : What were the consecutive actions you undertook after you discovered you suffered from your disorder? Waited for a while Looked for information General Practitioner Pharmacy General Practitioner Special Practitioner Something Else © InSites Consulting N Europe = 2841 / Filter = Patients suffering from at least one disorder Health Study 2010 | How to engage in the conversation with empowered patients | © InSites Consulting, 2010. 13

2010 83% already used the internet to look for information on health related topics (this is 50% when corrected to the offline population) 74% Users 80% 82% 72% 70% 95% 69% 79% 97% United States 83% Brazil 93% 79% Australia 79% © InSites Consulting 87% China 93% Health Study 2010 | How to engage in the conversation with empowered patients | © InSites Consulting, 2010. 14

2010 Information search How often do patients look for information about medical-related topics on the internet? In Europe, 77% already used the internet to look for health info. Which is a slight increase versus 2008 (75%). © InSites Consulting Health Study 2010 | How to engage in the conversation with empowered patients | © InSites Consulting, 2010. 15

43% Male Monthly 38% Male Less than monthly 62% even looks for Female 47% Female 53% online health info 18-24 47% 18-24 53% every month 25-34 35-44 45% 43% 25-34 35-44 55% 57% 45-54 38% 45-54 62% 28% in Western Europe 55-64 40% 55-64 60% 65+ 42% 65+ 58% 72% in Asia!!! © InSites Consulting Health Study 2010 | How to engage in the conversation with empowered patients | © InSites Consulting, 2010. 16

2010 Information search about YOUR DISORDER Q: Where did you already inform yourself about your disorder? A general practitioner 55% A specialist 33% Family 28% 59% Friends / acquaintances 24% Internet 23% A pharmacist 15% Health encyclopaedia (book) 12% 35% Magazines 11% (A) health article(s) I collected 8% Newspapers 7% Fellow patients Library 4% 6% 25% 23% * Remark: the data were collected via an online (A) patient folder(s) I collected 4% panel survey. The total use of the internet by patients was 40% in the sample. To avoid over- Patient organisations 2% estimation of the internet usage by patients (because the internet penetration in the sample Other 3% was 100%), the internet usage was corrected 7% based on the internet penetration in Europe. © InSites Consulting I did not look for information on my (Source = www.internetworldstats.com) 10% disease (yet) N total = 4327 / Filter = If at least one disorder. Health Study 2010 | How to engage in the conversation with empowered patients | © InSites Consulting, 2010. 18

Patients with the more % of patients with disorder ... who looked for online info on that disorder COMMON DISORDERS Hairloss 39% Menopause symptoms 37% use the Internet MOST Arthritis Bladder infection 33% 31% Libido impairment 30% Erectile dysfunction 29% Obesity 29% Depression 29% Heart problems 29% Stress 27% Anxiety 26% Fungal infection Hairloss 25% Sleep disorder 25% High blood pressure 24% Menopause Influenza Migraine 24% 24% Stomach problems Arthritis Warts 24% 24% Allergy 24% Bladder infection Chronic pain High cholesterol 23% 22% Bronchial infection 22% Libido impairment Diabetes 21% Sinusitis 21% Erectile dysfunction Gastroesophageal reflux disease 21% Itch 20% Muscle ache 19% Obesity Intestinal problem 19% Herpes labialis 19% © InSites Consulting Depression Headache 19% Heartburn 17% Asthma 16% Hearth problems N total = min 30 / Filter = © InSites Consulting, 2010. 19 Health Study 2010 | How to engage in the conversation with empowered patients |% within people with that disorder

People consulting the INTERNET about their disorder most often rely on… . © InSites Consulting Health Study 2010 | How to engage in the conversation with empowered patients | © InSites Consulting, 2010. 22

2010 1 Search engines! . 95% Country level Belgium 94% Netherlands 94% France 89% Germany 95% Switzerland 96% United Kingdom 95% Spain 97% Italy 97% Romania 96% Russian 97% Federation United States 81% Brazil 97% Australia 95% © InSites Consulting China 93% Health Study 2010 | How to engage in the conversation with empowered patients | © InSites Consulting, 2010. 23

No sponsored links bought by pharmaceutical companies © InSites Consulting Health Study 2010 | How to engage in the conversation with empowered patients | © InSites Consulting, 2010. 26

No sponsored links bought by pharmaceutical companies © InSites Consulting Health Study 2010 | How to engage in the conversation with empowered patients | © InSites Consulting, 2010. 27

People consulting the INTERNET about their disorder also often rely on… . © InSites Consulting Health Study 2010 | How to engage in the conversation with empowered patients | © InSites Consulting, 2010. 28

2010 2 Wikipedia! . 36% Country level Belgium 29% Netherlands 29% France 32% Germany 56% Switzerland 44% United Kingdom 38% Spain 34% Italy 43% Romania 31% Russian Federation 54% United States 25% Brazil 40% Australia 27% © InSites Consulting China 22% Health Study 2010 | How to engage in the conversation with empowered patients | © InSites Consulting, 2010. 29

2010 3 Government sites . 14% Country level Belgium 12% Netherlands 6% France 8% Germany 7% Switzerland 8% United Kingdom 36% Spain 10% Italy 11% Romania 4% Russian 5% Federation United States 10% Brazil 18% Australia 23% © InSites Consulting China 33% Health Study 2010 | How to engage in the conversation with empowered patients | © InSites Consulting, 2010. 30

2010 . 4 Medical portals 11% Country level Belgium 17% Netherlands 6% France 27% Germany 7% Switzerland 13% United Kingdom 10% Spain 11% Italy 7% Romania 6% Russian 7% Federation United States 30% Brazil 6% Australia 13% © InSites Consulting China 9% Health Study 2010 | How to engage in the conversation with empowered patients | © InSites Consulting, 2010. 31

2010 5 Pharmaceutical sites . 10% Country level Belgium 5% Netherlands 3% France 3% Germany 12% Switzerland 6% United Kingdom 7% Spain 8% Italy 5% Romania 17% Russian Federation 21% United States 6% YOUR SITES Brazil 13% Australia 8% © InSites Consulting China 13% Health Study 2010 | How to engage in the conversation with empowered patients | © InSites Consulting, 2010. 32

2010 Are the sites considered to be trustworthy? © InSites Consulting N = 1.739 / Filter : If the internet Health Study 2010 | How to engage in the conversation with empowered patients | © InSites Consulting, 2010. 33

2010 Consulted websites – regional differences Q: How did you look up info about your disorder on the Internet? Which websites did you consult? 0% 25% 50% 75% 100% General search engine 95% Wikipedia 36% Government health site 14% Medical portal broader health focus 11% Pharmaceutical company website 10% Site of a health centre / hospital 9% Site of a doctor’s practice 5% Via my social network 4% 10%> Total Site of health insurance companies 4% 10%< Total Site focused on specific syndrome 3% Patient community 2% Total Blog from a medical advisor 1% Western Europe Eastern Europe Patient blog 1% Southern Europe Northern America Other 2% Southern America Australia © InSites Consulting Asia Health Study 2010 | How to engage in the conversation with empowered patients | © InSites Consulting, 2010. 34

2010 Patients are most interested in the following types of content: 1 Treatment in general 2 New types of treatment 3 Side effects 4 Symptoms + impact 5 Co-morbidity © InSites Consulting Health Study 2010 | How to engage in the conversation with empowered patients | © InSites Consulting, 2010. 35

2010 Which content do patients require online? Q: To what extent would you be interested in the following content of online information on your disorder? 0% 25% 50% 75% 100% Treatment in general 69% New treatments 68% Asia Side effects of medication 67% Eastern Europe Symptoms of the disorder I suffer 65% South America Impact disease on quality of life 60% stronger Other disorders that typically co- interest 59% occur with my disorder Price 46% Specific brands of medication 45% Health care professionals 45% Total Western Europe Reimbursement 37% Eastern Europe Southern Europe Health insurance companies 24% Northern America Southern America Australia © InSites Consulting 10%> Total Asia 10%< Total Health Study 2010 | How to engage in the conversation with empowered patients | © InSites Consulting, 2010. 36

2010 Which content do patients require online? Q About which topics did youever read information online about your disorder? Q To what extent would you be interested in the following content of online information on your disorder? 100% Interest in online content Important 90% content 80% New treatments Treatment in general 70% Side effects of medication Symptoms of the disorder I Other disorders that typically suffer from 60% co-occur with my disorder Impact disease on quality of life Average 50% Specific brands of medication Price Health care professionals 40% Reimbursement 30% In general, patients Health insurance companies tend to find the info 20% they are looking for... 10% Less 0% pertinent Average 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Ever read online © InSites Consulting N Europe = 1.739 / Filter : If the internet is used for info on a disorder Health Study 2010 | How to engage in the conversation with empowered patients | © InSites Consulting, 2010. 37

2010 Conversation 1 The internet: an important source for today's patients. 2 Connected patients are CONVERSATING! 3 How can the industry activate the empowered patient? © InSites Consulting Health Study 2010 | How to engage in the conversation with empowered patients | © InSites Consulting, 2010. 38

2010 Patients interact outside of the doctor’s cabinet Q: To what extent do you agree with the following statements? (Top 2% agreement) Half of the 0% 25% 50% 75% consumers 100% When I feel something related to my health, I 49% DISCUSS discuss this with my family and/or friends about their When my doctor makes a health diagnosis, I check it with 31% my family and/or friends online and/or offline When I feel something, 14% I discuss this with other patients Total Western Europe When my doctor makes Eastern Europe a diagnosis, I check it 12% Southern Europe with other patients Northern America Southern America Australia © InSites Consulting 10%> Total Asia 10%< Total N = 5.777 / Filter : No filter applied Health Study 2010 | How to engage in the conversation with empowered patients | © InSites Consulting, 2010. 39

2010 Ever shared online information . Country level 12% 30% Belgium Netherlands 15% France 27% Germany 17% Switzerland 16% United Kingdom 17% Spain 24% Italy 37% Romania 32% Russian Federation 52% United States 19% Brazil 45% Australia 15% © InSites Consulting China 76% Health Study 2010 | How to engage in the conversation with empowered patients | © InSites Consulting, 2010. 40

2010 Patients interact outside of the doctor’s cabinet Q: About which topics did you ever share information online concerning your disorder? Asian patients SHARED TOPICS 0% 25% 50% share more in 75% 100% Treatment in general general. 49% Symptoms of the disorder I suffer 46% New treatments 41% Americans Impact disease on quality of life Side effects of medication 40% 40% share more info Other disorders that typically co- occur with my disorder 29% on prices. Specific brands of medication 25% Price 24% Health care professionals 20% Total Western Europe Reimbursement 9% Eastern Europe Southern Europe Health insurance companies 6% Northern America Southern America Other Australia © InSites Consulting 3% 10%> Total Asia N = 1.286 / Filter : If at least one disorder and shared information 10%< Total Health Study 2010 | How to engage in the conversation with empowered patients | © InSites Consulting, 2010. 41

2010 Patients interact outside of the doctor’s cabinet Q: Via which of the following channels did you ever share information online about your disorder? In Asia 0% 25% 50% 75% people 100% Via online fora/discussion boards/communities 14% share Via a social online more. 13% encyclopedia (Wikipedia) They also Via a personal site or blog 9% use Via social networks (Hyves, Facebook, Netlog, 7% more MySpace…) Via movie sharing 4% channels. networks (YouTube, Daily motion, Vimeo...) 2% Total Other Western Europe Eastern Europe Southern Europe None of the above 70% Northern America Southern America Australia © InSites Consulting 10%> Total Asia N = 1.286 / Filter : If at least one disorder and shared information 10%< Total Health Study 2010 | How to engage in the conversation with empowered patients | © InSites Consulting, 2010. 42

2010 Asian and Western European users are each others’ opposites when looking at their online behaviour! 79% of West European people are more open in person vs. online, which is only the case amongst 45% of Asian people. © InSites Consulting (c) InSites Consulting, Social network study 2010 : freely available on request! Health Study 2010 | How to engage in the conversation with empowered patients | © InSites Consulting, Filter = If 43 N Global = 2065 / 2010. user

2010 62% of online patients is active on social networks 56% 57% Users 70% 52% 68% 72% 61% 64% 59% United States 68% Brazil 77% 68% Australia 61% © InSites Consulting 68% China 45% N = 4.327 / Filter : If at least one disorder Health Study 2010 | How to engage in the conversation with empowered patients | © InSites Consulting, 2010. 44

2010 Type of friends patients have online Q: Which of the following friends are present in your online social network? 16% of social network users is 0% 25% 50% 75% connected with 100% People with the same disorder that I have, fellow patients that I know from the real world and I 16% they know have a lot of contact with in my offline life from real life. People with the same disorder that I have, 12% connects with that I do not know from the real 12% patients they do world not know. People with the same disorder that I have, Total and that I met offline, Western Europe 6% but I don’t have a lot Eastern Europe of contact with in my Southern Europe offline life Northern America Southern America Australia © InSites Consulting 10%> Total Asia N = 2.690 / Filter : If at least one disorder and member of a social network 10%< Total Health Study 2010 | How to engage in the conversation with empowered patients | © InSites Consulting, 2010. 45

2010 Popular social networks to share information about diseases Q On which of the following social networks did you read / share information about your disease? 15% Share information 10% Facebook, and to a lesser extent Twitter, MySpace and Windows Live Spaces are the most common networks to read/share info on diseases, 5% since they are also most commonly used in general. Average 0% Average 0% 5% 10% 15% 20% 25% Read information © InSites Consulting N = 2.690 / Filter : If at least one disorder and member of a social network Health Study 2010 | How to engage in the conversation with empowered patients | © InSites Consulting, 2010. 46

2010 © InSites Consulting Health Study 2010 | How to engage in the conversation with empowered patients | © InSites Consulting, 2010. 47

2010 Frequency of sharing information via social networks Q: How often do you share information about your disease on the following social networks? Regularly Friendfeed 3% 53% 16% 18% 9% 56% n = 30 Flickr n = 20 14% 33% 33% 5% 15% 47% LinkedIn 9% 35% 14% 13% 29% 44% n = 21 XING 10% 31% 23% 22% 14% 41% n = 22 Hyves 4% 28% 19% 20% 29% 32% n = 25 MySpace 6% 20% 31% 30% 13% 26% n = 100 Netlog 9% 14% 17% 25% 35% 23% n = 54 Twitter 9% 13% 36% 35% 7% 22% n = 111 Windows Live Spaces 7% 12% 29% 33% 19% 19% n = 112 Facebook 4% 10% 28% 28% 30% 14% n = 354 Other 4%1% 28% 27% 41% 5% n = 86 Very often Regularly Now and then Rarely Hardly ever © InSites Consulting N = 2.690 / Filter : If at least one disorder and member of a social network Health Study 2010 | How to engage in the conversation with empowered patients | © InSites Consulting, 2010. 51

2010 33% of online patients read about their disease on communities 49% 36% Users 14% 25% 31% 72% 17% 24% 25% United States 34% Brazil 47% 31% Australia 26% © InSites Consulting 34% China 59% N = 4.327 / Filter : If at least one disorder Health Study 2010 | How to engage in the conversation with empowered patients | © InSites Consulting, 2010. 53

2010 Community membership and participation Q: Are you member of any of the following communities on your disorder? Q: On which of the following communities did you read information about your disorder? Q: On which of the following communities did you share information about your disorder? Member Read Share A community organized by a pharmaceutical company 3% 9% & 5% A community organized by a patient organization 4% 8% & 6% A community organized by fellow patients 3% 9% & 7% Communities organized by the government 4% 7% & 4% Communities of which I do not know the organizer 3% 13% & 8% Other communities 1% 2% & 1% © InSites Consulting N = 4.327 / Filter : If at least one disorder Health Study 2010 | How to engage in the conversation with empowered patients | © InSites Consulting, 2010. 57

2010 Interest in different community types Q: To what extent would you be interested in the following type of communities for patients of your disorder? 0% 25% 50% 75% 100% A community where you can ask the opinion of a An advisory 49% health care professional community A community where you by HCPs and can ask the opinion of 35% pharmaceutical pharmaceutical companies companies clearly has A community with testimonials of potential !!! 33% patients Total Western Europe A community where Eastern Europe patients can become 21% Southern Europe Northern America friends Southern America Australia © InSites Consulting 10%> Total Asia N = 4.327 / Filter : If at least one disorder 10%< Total Health Study 2010 | How to engage in the conversation with empowered patients | © InSites Consulting, 2010. 58

2010 Conversation 1 The internet: an important source for today's patient! 2 Connected patients ARE conversating! 3 How can the industry ACTIVATE the empowered patient? © InSites Consulting Health Study 2010 | How to engage in the conversation with empowered patients | © InSites Consulting, 2010. 59

According to consumers, pharmaceutical companies should… . © InSites Consulting Health Study 2010 | How to engage in the conversation with empowered patients | © InSites Consulting, 2010. 60

2010 1 Provide info in cabinet . 56% Romania 83% Russian Federation 73% Brazil 57% Belgium 57% Netherlands 57% Australia 56% United States 55% Italy 54% United Kingdom 52% Germany 51% Switzerland 48% France 48% Spain 46% China 39% © InSites Consulting Sig. Difference between countries (95%) Health Study 2010 | How to engage in the conversation with empowered 5.777 / FilterInSites Consulting, 2010. N = patients | © : No filter applied 61

2010 Provide expert guidance 2 on a website 52% . Romania 76% Russian Federation 74% China 66% Italy 58% Germany 55% Brazil 55% Spain 53% United States 49% Switzerland 48% France 47% Australia 45% United Kingdom 44% Belgium 33% Netherlands 31% © InSites Consulting Sig. Difference between countries (95%) Health Study 2010 | How to engage in the conversation with empowered 5.777 / applied No filter applied 2010. N = 5.777 / Filter := patients | © InSites Consulting, N No filter Filter : 62

2010 Be in constant dialogue 3 with patients 51% . Romania 76% Brazil 68% Russian Federation 65% China 60% Italy 54% Switzerland 53% Germany 53% United States 49% France 47% Spain 46% United Kingdom 37% Belgium 37% Australia 34% Netherlands 33% © InSites Consulting Sig. Difference between countries (95%) Health Study 2010 | How to engage in the conversation with empowered 5.777 / FilterInSites Consulting, 2010. N = patients | © : No filter applied 63

2010 Make discussions about How can the industry engage the empowered patient? 4 The role of the industry medication possible on their site Romania 72% Russian Federation 67% 49% Brazil China United States 59% 56% 55% France 46% United Kingdom 46% Germany 46% Switzerland 44% Spain 44% Australia 44% Italy 41% Netherlands 35% Belgium 28% © InSites Consulting Sig. Difference between countries (95%) Beware: adverse Health Study 2010 | How to engage in the conversation with empowered 5.777 / FilterInSites Consulting, 2010. event reporting necessary N = patients | © : No filter applied 64

Q: If you consider the information you have read/already read online, how would you describe the tone of voice of this information? The majority of online conversations is positive, especially when they are about medication Negative Positive In general 19% 40% On medication 18% 50% © InSites Consulting Health Study 2010 | How to engage in the conversation with empowered patients | © InSites Consulting, 2010. 65

2010 Measuring the temperature of online conversations Q: If you had a serious complaint about a pharmaceutical drug or treatment for your 5% disorder, how often would you share this information on the Internet? 10% 22% Frequency sharing complaint 19% 5% 10% (‘Only’) 5% has the intention 22% to always to share complaints 43% 19% about treatments/drugs online. Always Often 43% From time to time Hardly ever Never Always Often From time to time © InSites Consulting Hardly ever N = 4.327 Never : If at least one disorder / Filter Health Study 2010 | How to engage in the conversation with empowered patients | © InSites Consulting, 2010. 66

2010 Share info on medication in social How can the industry engage the empowered patient? 5 The role of the industry encyclopedia 45% Romania Russian Federation Brazil 55% 68% 65% China 53% Germany 48% Switzerland 47% Italy 42% United States 41% Netherlands 40% United Kingdom 35% Spain 35% France 35% Australia 35% Belgium 34% © InSites Consulting Sig. Difference between countries (95%) Health Study 2010 | How to engage in the conversation with empowered 5.777 / FilterInSites Consulting, 2010. N = patients | © : No filter applied 68

Remember: 2nd most frequented source for health related information! © InSites Consulting Remember: a neutral point of view. Advocate no single point of view! Health Study 2010 | How to engage in the conversation with empowered patients | © InSites Consulting, 2010. 69

2010 How can the industry activate the empowered patient? Q: Pharmaceutical companies are one of the possible information sources for patients. To what extent do you agree with the following statements? Pharmaceutical companies should… 0% 25% 50% 75% 100% Provide patient info in the doctor’s office/ pharmacy 56% Possibility to get guidance from an expert 52% Be in dialogue with patients 51% Possibility to discuss medication on their website 49% Share info about their brands in social encyclopedia 45% Be involved in discussions on disorders & products 38% on social media Sponsor websites of patient organisations 32% Have a patient page where patients can become friends 29% Make YouTube movies on the disorder / product usage 28% Sell their drugs to patients online 25% Advertise about products in newspapers/magazines 24% Advertise about their products on television 22% Total Western Europe Share press releases and other relevant info on Twitter 19% Eastern Europe Southern Europe Advertise about their products on the radio 17% Northern America Make a Facebook page 16% Southern America Australia © InSites Consulting Asia 10%< Total 10%> Total N = 5.777 / Filter : No filter applied Health Study 2010 | How to engage in the conversation with empowered patients | © InSites Consulting, 2010. 70

2010 How can the industry engage the empowered patient? Take the industry forward Taking the industry 48% is interested in a doctor Some options to take the who can be consulted online health industry © InSites Consulting N = 4.327 / Filter : If at least one disorder Health Study 2010 | How to engage in the conversation with empowered patients | © InSites Consulting, 2010. 73

2010 How can the industry engage the empowered patient? Take the industry forward Taking the industry 48% is interested in a doctor Some options to take the who can be consulted online health industry 38% wants less paperwork: prescriptions automatically shipped 34% wants to buy products in online pharmacies 27% wants automatic SMS reminders for doctor appointments 22% wants automatic SMS reminders for medication intake © InSites Consulting N = 4.327 / Filter : If at least one disorder Health Study 2010 | How to engage in the conversation with empowered patients | © InSites Consulting, 2010. 75

Patients ARE engaged and conversating and they are clearly ready to be activated online by HCPs and the broader industry! © InSites Consulting Health Study 2010 | How to engage in the conversation with empowered patients | © InSites Consulting, 2010. 77

2010 Using Social Media Nethnography in Health Research Tapping into the conversations of connected patients and caregivers Prof. Dr. Niels Schillewaert Managing Partner InSites Consulting Director ForwaR&D Lab June 2010

limitations of interview based techniques © InSites Consulting InSites Consulting ForwaR&D Lab 80

Would not we want to do this? © InSites Consulting InSites Consulting ForwaR&D Lab 81

Life Caching Social Media Nethnography

emotions interviewing bias contextual information Long time periods consumer insights © InSites Consulting InSites Consulting ForwaR&D Lab 83

 81.861 1/01/2007 – 01/06/2009 © InSites Consulting InSites Consulting ForwaR&D Lab 84

Quality of Life Longevity Health Daily life problems impact Elderly diseases discussed online © InSites Consulting InSites Consulting ForwaR&D Lab 85

Diseases associated with getting older Psychological and physical problems Psychological Physical problems problems 11% 8% 19% Other topics 62% © InSites Consulting InSites Consulting ForwaR&D Lab 86

Major diseases when getting older? Top 20 discussed diseases dementia 5627 cardiovascular 4733 overweight 4452 vision loss 3584 alzheimer 3477 stress 2684 memory loss 2614 emotional dysregulation mood 2094 cancer 1749 head problem 1732 foot toe ankle 1685 gastro 1608 mobility issues 978 anxiety 970 muscle problems 909 lung problems 905 diabetes 895 incontinence 859 physical inflammation 793 psychotic 737 psychological parkinson 736 joints arthritis 706 skeleton © InSites Consulting 622 skin issues 616 sleep problems 522 InSites Consulting ForwaR&D Lab 87

People tend to discuss more about lethal diseases 0,45 correlation Some exceptions - Cancer © InSites Consulting - Lung problems InSites Consulting ForwaR&D Lab 88

Emotions about aging concerns across disease states Sentimeter Decision Friends Safety Religion Active Eating Diagnosis Transport Professional » Finding right Clothes Dog Housing treatment not easy Personal Payment care Law Diseases » Never ending Identity Treatment Guilt Telephone call © InSites Consulting Buzz volume InSites Consulting ForwaR&D Lab 89

Emotions about health care professionals Sentimeter Hospice Caregivers Assisted living Legal Paying organisation Dentist Nurse Specialist Nursing home Hospital Pharmacists GP Ambulance © InSites Consulting Buzz volume InSites Consulting ForwaR&D Lab 90

Alzheimer Drugs Share of voice N = 3477 F = Posts about Alzheimer aricept 49% reminyl 13% namenda 11% paxil 11% N = 305 risperdal 10% 91% 9% exelon 9% seroquel 8% zyprexa 4% Drugs mentioned No drugs mentioned prozac 3% coumadin 3% © InSites Consulting InSites Consulting ForwaR&D Lab 91

Alzheimer Drugs Consideration set N = 305 F = Posts about Alzheimer & Drugs 14% Risperdal 0% Aricept 1 brand 34% 13% Seroquel 10% Paxil ! 0% Namenda 0% Reminyl 72% Aricept 2 brands 36% 9% Namenda 5% Reminyl 77% Aricept 3 or more 37% Reminyl 30% brands 27% Namenda © InSites Consulting InSites Consulting ForwaR&D Lab 92

Alzheimer Drugs Sentimeter Posts about Posts about Posts about Posts about All posts AH Drugs Aricept Namenda Reminyl 100 100 100 100 100 90 90 90 90 90 Comparison with 80 80 80 80 80 sentiment across brands 70 70 70 70 70 Significantly higher 60 60 60 60 60 No significant difference Significantly lower 50 50 50 50 50 40 40 40 40 40 30 30 30 30 30 20 20 20 20 20 0 0 0 0 0 60° 24° 9° 12° 66° N=81861 N=878 N=644 N=235 N=193 © InSites Consulting InSites Consulting ForwaR&D Lab 93

Alzheimer Drugs Sentimeter Posts about Posts about Posts about Posts about All posts AH Drugs Aricept Namenda Reminyl 100 100 100 100 100 90 90 90 90 90 Comparison with 80 80Why are 80 posts for 80 80 sentiment across brands 70 Reminyl so positive? 70 70 70 70 Significantly higher 60 60 60 60 60 No significant difference Significantly lower 50 50 50 50 50 40 40 40 40 40 30 30 30 30 30 20 20 20 20 20 0 0 0 0 0 60° 24° 9° 12° 66° N=81861 N=878 N=644 N=235 N=193 © InSites Consulting InSites Consulting ForwaR&D Lab 94

Alzheimer Drugs Sentimeter Posts about Reminyl 100 youngest  hopeful 90 80 in action when dominant brands lost efficacy 70 60 50 later stages of Alzheimer disease Why are posts for 40 Reminyl so positive? 30 Aricept made a wonderful difference in the 20 quality of life for my Mom. However, for Mom had a runny nose the some people it does not help at all. The 0 we've been through all entire time she was taking newest AD med to be approved by the the AD meds (Aricept, Aricept. (…) I'm hoping FDA is Reminyl. Ask her doc if he/she 66° Exelon) she's now taking Reminyl does not have this thinks this is an option for your Mom. For Reminyl side effect. information on the drug take a look at this web site. Reminyl N=193 This study suggests that Reminyl may provide long-term benefits in treating AD by delaying symptom progression observed over the course of three years. Dementia is an umbrella word for different types of dementia,as there are 50 or more diseases that can cause dementia.Alzheimer's is just one of them.Aricept is a good medication,I was on it 4 years,then when It stopped working well,I started taking Reminyl.I've been on it 3 yrs.Yes I have Alzheimer's,but I still have a life (…) © InSites Consulting InSites Consulting ForwaR&D Lab 95

Alzheimer Drugs Sentimeter 2,0 2,0 1,5 Alzheimer 1,5 1,0 Alzheimer Drugs 1,0 0,5 0,5 0,0 0,0 -0,5 -0,5 -1,0 -1,0 -1,5 -1,5 -2,0 2005 2005 2006 2006 2007 2007 2008 2008 2009 -2,0 (1-6) (7-12) (1-6) (7-12) (1-6) (7-12) (1-6) (7-12) (1-6) 2005 2005 2006 2006 2007 2007 2008 2008 2009 (1-6) (7-12) (1-6) (7-12) (1-6) (7-12) (1-6) (7-12) (1-6) She is on Aricept now but this is only because I believed she had a need for it due to obsessive behaviors accompanied by self harm Absolutely! ...not that my mom has ever been on Aricept, nor has she had the same compulsions as your MIL. But her behaviors can be more than I have her on Aricept right now but I also want to maddening and many times are scary and make clear it was not for the purpose of trying to dangerous, as well. stop the disease it was to try and quell the destructive behaviors. Uh ya know I may have spoke too soon... I may be mistaken but I think the Aricept may be working © InSites Consulting InSites Consulting ForwaR&D Lab 96

Alzheimer Drugs Sentimeter 2,0 2,0 1,5 Alzheimer 1,5 1,0 Alzheimer Drugs 1,0 0,5 0,5 0,0 0,0 -0,5 -0,5 -1,0 -1,0 -1,5 -1,5 -2,0 2005 2005 2006 2006 2007 2007 2008 2008 2009 -2,0 (1-6) (7-12) (1-6) (7-12) (1-6) (7-12) (1-6) (7-12) (1-6) 2005 2005 2006 2006 2007 2007 2008 2008 2009 (1-6) (7-12) (1-6) (7-12) (1-6) (7-12) (1-6) (7-12) (1-6) Hun if this is a different behavior than before Aricept (now) then I would look to that drug as the cause. Aricept worked for 2 years for my mother and hubby. The doctor at the VA would not consider I'm getting quite sick of reading my patients charts to find Namenda. He thought is was over rated for one. they are on Aricept and its clearly NOT working on them. I The other was he feared it may enhance the don't get this drug the behaviors it produces is like nothing symptoms of bad behavior. else I’ve seen (…) Needless to say, we took him off after the 5th dose. It was like night and day different. He was hard to get along with before and after Aricept, but with it he © InSites Consulting was impossible. InSites Consulting ForwaR&D Lab 97

 39.812 1/06/2008 – 31/10/2008 © InSites Consulting InSites Consulting ForwaR&D Lab 98

30 information segments bottom-up segmentation Diagnosis Health care Driving Confused Brand C Side effects Helpful Problem Seizures Job Having pain Control normal behaviour Wishes for thefuture School night Husband Important Scared Satisfaction Headache Awareness & Difficult knowledge Treatment Children Dosage Food & drinks Brand A © InSites Consulting Budget Brand B InSites Consulting ForwaR&D Lab 99

25% Natural & medical language about seizures © InSites Consulting InSites Consulting ForwaR&D Lab 100

Natural explanations seizure types PETIT MAL Also called ‘absence’ People just stand and stare vacantly My mind was wandering, blank, in a daze When asked to speak, would talk then just go blank and lose my entire train of thought and having no idea what I had implied My eyes would blink rapidly and then I would go blank as if I were daydreaming and my mind would be shot © InSites Consulting InSites Consulting ForwaR&D Lab 101

Societal concerns around Epilepsy Society Epileptic unit = CONTROL SEIZURES Lack of knowledge Caregiver (mainly family) STIGMA EMBARRASMENT Limited Epilepsy patient understanding Unsuccesful succesful control control Decrease in social life Confidence Adapt family activities Lose job Can no longer be alone © InSites Consulting InSites Consulting ForwaR&D Lab 102

Brands : A matter of sentiment Brand A Brand B Brand C Brand D Brand E 100 100 100 100 100 90 90 90 90 90 80 80 80 80 80 70 70 70 70 70 60 60 60 60 60 50 50 50 50 50 40 40 40 40 40 30 30 30 30 30 20 20 20 20 20 0 0 0 0 0 59 39 49 38 20 Brand F Brand G Brand H Brand I Brand J 100 100 100 100 100 90 90 90 90 90 80 80 80 80 80 70 70 70 70 70 60 60 60 60 60 50 50 50 50 50 40 40 40 40 40 30 30 30 30 30 20 20 20 20 20 0 0 0 0 0 33 21 22 65 90 © InSites Consulting InSites Consulting ForwaR&D Lab 103

Brand A : sentimeter Positive comments about Brand A are mainly related to the fact that the medication works for patients http://www.epilepsynse.org.uk/Forum/viewtopic.php? Brand A has been a fabulous f=3&t=17307&sid=0eb3257cbd1edbe84dddd0f775fc3 med for my daughter. She has Brand A 8f1 not experienced any negative side effects. 100 90 80 70 60 I'm laughing more easily and it's easier to be happy again. AnD 50 I've been on Brand A it's not eating up my memory like 40 for about a year and the Brand H. To be honest, at 30 have only had once this point I think the Brand A is a 20 seizure since. Side LOT better than Brand H effects that I have are 0 occasional dizzyness, 59° shakiness, and spotted vision. But other than that, I'm pretty happy. I Brand A helped me to stop having the weird deju vu feeling I would have in my was started out on head. I dont black out so I would have these weird feelings like I had been in Brand B and that didn't this place before but when I started taking Brand A it really helped those weird work feeling in my head to go away. © InSites Consulting Total sample Brand Brand A InSites Consulting=ForwaR&D n = 1460 n = 39812 n 4649 Lab 104

Hormones, birth control, pregnancy & Brand A 94% of the conversations about hormones & Brand A are related to Pregnancy Brand A controls Is Brand A safe during Hormones Seizures seizures pregnancy? From the research that I have done on pregnancy and seizures, I found Brand B and Brand A to be listed as the safe meds to be on. Seizures Control Add birth successful unsuccessful control controlled He told me that it was pretty safe, but that there was not enough participation in research for it to be approved to be taken Brand A limits during pregnancy by the FDA. If you do Wish to start a Birth control decide to get pregnant and still stay on is barrier effects birth Brand A I recommend that you join the family control pregnancy registry. Here is the information: … . The website is http://www.Brand A.com/pc/livin...h_epilepsy/women2.asp Successful not clear when pregnancy ovulating © InSites Consulting InSites Consulting ForwaR&D Lab 105

Insight generation themes & keywords hypotheses & blind spots Brand analyses volume sentiment associations strengths & weaknesses Advertising impact track campaign reach, sentiment, brand fit Product post hoc (launch) performance © InSites Consulting InSites Consulting ForwaR&D Lab 106

Natural & medical language about disease Learn what consumers tell each other Find hidden patterns – blind spots Optimize online marketing strategy © InSites Consulting InSites Consulting ForwaR&D Lab 107

Answers to questions you did not ask Answers without asking questions © InSites Consulting InSites Consulting ForwaR&D Lab 108

1. Information needs & interviewing self-generation  new patient insights actual & contextual information  natural language & emotions reduced interviewing bias 2. Sampling practical significance long periods of time 3. field & analysis unit of analysis qual – quant reporting style © InSites Consulting connection between client & agency InSites Consulting ForwaR&D Lab 109

Can you hide the elephant? For SMN unclear rules  MR rules “real” patient + reporter + event + MAH’s brand Process Training Report AE < 24 hrs Analyze verbatims until max AE reached Do not be afraid Pharmacovigilance group  capacity limit Not all posts read © InSites Consulting InSites Consulting ForwaR&D Lab 110

What can you expect? 7% 0.2% It depends ... – platform – public – product – theme © InSites Consulting InSites Consulting ForwaR&D Lab 111

Lessons learned & limitations  Social Media Nethnography is not a short cut Analyse and audit, then track Time investment for client and agency required through iterative process AE reporting  It is still developing AER rules Language & dictionaries Limited profile information Upfront feasibility check for critical mass  We still need to ask questions Only the question follows the answers – a bit like Jeopardy Complementary to interview based research © InSites Consulting InSites Consulting ForwaR&D Lab 112

2010 AstraZeneca prescription forecasting study Summary Pan-EU Physician Research Sarah Mertens Customer Insight Director International Marketing organisation AstraZeneca Pharmaceuticals June 2010

Online HCP research © InSites Consulting Health Study 2010 | How to engage in the conversation with empowered patients | © InSites Consulting, 2010. 115

Internet surveys among HCPs No deviation in results from other methods Internet access HCPs above 90% and more Most preferred method ((c) EphMRA, 2006!) © InSites Consulting Health Study 2010 | How to engage in the conversation with empowered patients | © InSites Consulting, 2010. 116

Strict verification of HCP identity Clear agreements (timing / reimbursement) Devoted time invested Strict quality control possible (fill-out time) In their natural setting At their own convenience No interviewer bias / differences Strict screening = useful participation Automated filtering = relevant questions Integration of (audio-)visual stimuli © InSites Consulting Health SMARTEES 2010 119

Methodology and objectives © InSites Consulting Health Study 2010 | How to engage in the conversation with empowered patients | © InSites Consulting, 2010. 120

Methodology Online survey A large Pan-European study Online survey Recruitment on a large independent physician panel In total 476 specialists participated The study was done in a blinded way (unbranded) © InSites Consulting Health SMARTEES 2010 121

Key study objectives Prescription mapping and forecasting Context Indication 1, 2, 3 Product b Product b Product a Product a Indication 1 Indication 2, 3 Indication 1, 2, 3 Product b Year -7 Year -2 Year 0 Year +0.5 Year > +1 … Rx known Rx known Rx known Rx known Rx ? © InSites Consulting Health SMARTEES 2010 122

Key study objectives Prescription mapping and forecasting Quantify the current prescription behaviour and future switch intention among specialists upon further market introduction of product a by AstraZeneca. Understand the drivers & barriers to switch from current treatments – including product b by AstraZeneca, which approaches end of patent – to product a. © InSites Consulting Health SMARTEES 2010 123

Current self-reported prescription behaviour Based on report by the physicians: Please think of the last 11 prescriptions made for indication... = easy to fill out Research population should be close match with targeted prescription population; good agreement on screener questions is required ! Up-to-date prescription data (if available to the company) can be used to reweight self-reported prescription and future intended prescription © InSites Consulting Health Study 2010 | How to engage in the conversation with empowered patients | © InSites Consulting, 2010. 124

Self-reported prescription shares Distribution across treatments Q : Please think about the last 11 times that you prescribed a product for Indication 1 / Indication 2 / Indication 3. Can you please indicate for each of the following products how many of the 11 times you have used each of the following products? Indication 1 Indication 2 Indication 3 13% 15% 25% 10% 13% Other products Abilify Risperdal Zyprexa Seroquel IR Seroquel XR Other products Abilify Risperdal Zyprexa Seroquel IR Seroquel XR Other products Abilify Risperdal Zyprexa Seroquel IR Seroquel XR 17% 20% 20% 20% 28% 17% 13% 16% 28% 17% 13% 16% 28% 24% 7% 7% 7% 31% 16% 21% 5% Product a Product a 12% Product a Seroquel XR 12% Seroquel XR Seroquel XR 14% Product b Seroquel IR Product b Seroquel IR Product b Seroquel IR 9% Zyprexa c Product Zyprexa c Product Zyprexa c Product Risperdal d Product 25% Risperdal d Product Risperdal d Product 18% Product e Abilify Product e Abilify 19% Product e Abilify Other Other products Other Other products Other Other products © InSites Consulting N = 476 / F = No filter applied Health SMARTEES 2010 125

Self-reported prescription shares Distribution across treatments Q : Please think about the last 11 times that you prescribed a product for Indication 1. Can you please indicate for each of the following products how many of the 11 times you have used each of the following products? Indication 1 Total Product a+b 10% 10% 13% 15% 16% 15% EU average 8% 7% 10% 14% 9% 6% 23% 20% 28% 21% 7% 24% 24% 25% 33% 23% 25% 21% 29% 16% 21% 17% Product a Seroquel XR Product b Seroquel IR 15% Zyprexa c Product 14% 12% 11% 18% 13% Risperdal d Product Product e Abilify 18% 20% 21% 20% Other Other products 12% 16% © InSites Consulting N (Total) = 476; N (Belgium) = 100; N (Germany)= 102; N (Spain) = 100; N (Italy) = 100; N (Sweden) = 74 / F = No filter applied Health SMARTEES 2010 126

Intended prescription behaviour Neutral introduction of new product is required, focus on key product characteristics Research setting = informed setting (all participants have access to the same product information) For extrapolation to real market situation: if only x% of the target group is informed about / has access to the new product, research data have to be adjusted © InSites Consulting Health Study 2010 | How to engage in the conversation with empowered patients | © InSites Consulting, 2010. 127

Intended shift in prescription share Indication 1 Q : Please think about the last 11 times that you prescribed a product for Indication 1. Can you please indicate for each of the following products how many of the 11 times you have used each of the following products? Q : Please think now about the next 11 times that you will prescribe a product for Indication 1. Can you please indicate for each of the following products how many of the 11 times you intend Current prescriptions Intended prescriptions 13% 23% 10% 27% 34% 7% Other products Abilify Risperdal Zyprexa Seroquel IR Seroquel XR Other products Abilify Risperdal Zyprexa Seroquel IR Seroquel XR 20% 28% 17% 13% 16% 24% 7% 20% 21% 17% Product a Seroquel XR 14% Product b Seroquel IR Zyprexa c Product 13% Risperdal d Product 18% Product e Abilify 15% Other Other products © InSites Consulting N = 476 / F = No filter applied Health SMARTEES 2010 128

Intended shift in prescription share Indication 1 Q : Please think about the last 11 times that you prescribed a product for Indication 1. Can you please indicate for each of the following products how many of the 11 times you have used each of the following products? Q : Please think now about the next 11 times that you will prescribe a product for Indication 1. Can you please indicate for each of the following products how many of the 11 times you intend 1% 6% 6% 11% 9% 17% 10% 22% 27% 12% 15% 26% 13% 27% 10% 15% 29% 20% 12% 16% 32% 34% 33% 18% 38% 28% 39% 33% 7% 6% 24% 8% 6% 21% 6% 7% 10% 7% 14% Abilify Risp erdal Zyp rexa Sero q uel IR Sero q uel XR 9% 7% 20% 9% 33% 25% 23% 20% 20% 19% 20% 29% 25% 29% 16% 23% 13% 21% 17% 17% 22% 16% 11% 15% 12% 12% 11% 13% 18% 14% 13% 10% 16% 12% 20% 28% 17% 7% 20% 19% 21% 20% 17% 15% 16% 16% 12% 9% 12% Product a Seroquel XR Product b Seroquel IR Current prescription shares Zyprexa c Product Risperdal d Product © InSites Consulting Product e Abilify N(total) = 476; N(Belgium) = 100; N(Germany) = 102; N(Spain) = 100; N(Italy) = 100; N(Sweden) = 74 / F = No filter applied Other Other products Health SMARTEES 2010 129

Intended shift in prescription share Intention to switch to Product a in Indication 1 Current prescriptions Intended prescriptions 100% of future Product a prescriptions If we consider the future prescription intention for Product a, where will the prescriptions then come from? 38% 48% Product a 57% = 13% of total = 27% of total 7% 8.5% Product b prescriptions prescriptions 11% 14% Product c Product a 12% 15% Product d Product a 3% 3.5% Product e 9% 11% Other products 43% = 10% of total Product b prescriptions Product b = 7% of total 21% prescriptions Product a+b = Product a+b = 23% 34% of total prescription share of total prescription share in Indication 1 in Indication 1 (13% a / 10% b) (27% a / 7% b) The total prescription share of Product a it expected to increase for Indication 1, even if all the remaining Product b prescriptions – the ones that are not converted into Product a – © InSites Consulting would be lost to generics. Health SMARTEES 2010 130

Intended shift in prescription share Drivers and barriers to switch in Indication 1 Current prescriptions Intended prescriptions Drivers to switch to product a  Better compliance  Good tolerability profile 57%  Good symptom control Product a  Effective Product a  ... 43% Product b Product b Barriers to switch to product a  Change current habits  Doubts on efficacy  Metabolic effects  Costs  Good reaction on product b  ... © InSites Consulting Health SMARTEES 2010 131

Are the results really what we can expect? Remember: perfect information and availability of the product is the starting point; if this will not be (immediately) the case in the market, we should balance the data But what about the research participants? Maybe they are more open to change compared to the overall physician population? And can we really compare the results of different markets? Maybe in certain countries they are more likely to be give positive answers? We need to rule out any differences that might occur naturally between individuals and between cultures. © InSites Consulting Health Study 2010 | How to engage in the conversation with empowered patients | © InSites Consulting, 2010. 132

Intended shift in prescription share A positive openness to switch to Product a A priory switching intention: assuming a new product was available with specifications considered appropriate by the specialists, 7 in 10 specialists reports an openness to switch patients to it. Switching intention for Product a: if we ask the same question for Product a (i.e. future intention to prescribe it), we see that 7.5 in 10 specialists reports an openness to switch patients to it and/or the intention to continue prescribing Product a to patients who are already on it. Switch Potential Index: Switching intention for a specific product – A Priori switching intention SPI = A Priori switching intention © InSites Consulting Health SMARTEES 2010 133

Intended shift in prescription share Differences in SPI across markets and indications A positive SPI score means that specialists are more open to switch to Product a compared to ‘a new product’ introduced in the category that would live up to their expectations. Below an overview of the SPI scores is given: Indication 1 -0.03 0.48 -0.13 -0.02 0.11 Indication 2 -0.07 0.37 -0.01 -0.07 0.06 Indication 3 0.07 0.39 -0.02 0.14 0.11 From the overview we can conclude that German and Swedish specialists currently display a bigger openness to switch to / stick to Product a compared to their colleagues in the other countries. © InSites Consulting Health SMARTEES 2010 134

How do we use the insights in practice? © InSites Consulting Health Study 2010 | How to engage in the conversation with empowered patients | © InSites Consulting, 2010. 135

From market insights to practice What is done with findings? Intermediate discussion of the results with business intelligence Presentation of the findings to the business / brand teams Discussion of the findings and challenging data with other insights available Internal presentation round of relevant insights by the business / brand teams Match results with market reality over time Repeat measure after x time for benchmarking / keeping the finger on the pulse © InSites Consulting Health SMARTEES 2010 136

Questions? © InSites Consulting Health Study 2010 | How to engage in the conversation with empowered patients | © InSites Consulting, 2010. 137

Let’s have a bite © InSites Consulting Health Study 2010 | How to engage in the conversation with empowered patients | © InSites Consulting, 2010. 139

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