Social Media In Health Care: FDA Limits Liquid Morphine

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

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

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 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)

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

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

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 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

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:
[email_address]

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Social Media In Health Care: FDA Limits Liquid Morphine

by Christian Sinclair, MD

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