Social Media in Health Care Case Study: FDA Removing Morphine Christian 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

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?) On March 31 st , the FDA issued a memo effectively ending the production and distribution of morphine 20mg/ml liquid along with other opioids Thursday

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?)

On March 31 st , the FDA issued a memo effectively ending the production and distribution of morphine 20mg/ml liquid along with other opioids Thursday

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. On March 31 st , the FDA issued a memo effectively ending the production and distribution of morphine 20mg/ml liquid along with other opioids Thursday

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.

On March 31 st , the FDA issued a memo effectively ending the production and distribution of morphine 20mg/ml liquid along with other opioids Thursday

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 On March 31 st , the FDA issued a memo effectively ending the production and distribution of morphine 20mg/ml liquid along with other opioids Thursday

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

On March 31 st , the FDA issued a memo effectively ending the production and distribution of morphine 20mg/ml liquid along with other opioids Thursday

April 1 st – 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) On March 31 st , the FDA issued a memo effectively ending the production and distribution of morphine 20mg/ml liquid along with other opioids Thursday

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)

On March 31 st , the FDA issued a memo effectively ending the production and distribution of morphine 20mg/ml liquid along with other opioids Thursday

April 2 nd 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 2 nd On March 31 st , the FDA issued a memo effectively ending the production and distribution of morphine 20mg/ml liquid along with other opioids Thursday

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 2 nd

On March 31 st , the FDA issued a memo effectively ending the production and distribution of morphine 20mg/ml liquid along with other opioids Thursday

April 2 nd 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 On March 31 st , the FDA issued a memo effectively ending the production and distribution of morphine 20mg/ml liquid along with other opioids Thursday

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

On March 31 st , the FDA issued a memo effectively ending the production and distribution of morphine 20mg/ml liquid along with other opioids Thursday

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 On March 31 st , the FDA issued a memo effectively ending the production and distribution of morphine 20mg/ml liquid along with other opioids Thursday

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

On March 31 st , the FDA issued a memo effectively ending the production and distribution of morphine 20mg/ml liquid along with other opioids Thursday

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? On March 31 st , the FDA issued a memo effectively ending the production and distribution of morphine 20mg/ml liquid along with other opioids Thursday

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?

On March 31 st , the FDA issued a memo effectively ending the production and distribution of morphine 20mg/ml liquid along with other opioids Thursday

Thursday, April 9 th - 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 On March 31 st , the FDA issued a memo effectively ending the production and distribution of morphine 20mg/ml liquid along with other opioids Thursday

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

On March 31 st , the FDA issued a memo effectively ending the production and distribution of morphine 20mg/ml liquid along with other opioids Thursday

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) On March 31 st , the FDA issued a memo effectively ending the production and distribution of morphine 20mg/ml liquid along with other opioids Thursday

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?

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

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.

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

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

On March 31 st , the FDA issued a memo effectively ending the production and distribution of morphine 20mg/ml liquid along with other opioids Thursday

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: [email_address]

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:

[email_address]