Partnership for Safe Medicines' original research: A Day in the life of illegal online drug sellers using social media by Alsberg Felllow Tim Mackey.

1. PSM Original Research: Timothy Ken Mackey, MAS
IHLS Senior Research
A Day in the Life of Illegal Online Drug Sellers Associate
Using Social Media PSM Carl L. Alsberg
Fellow
©2012

2. Direct-to-Consumer Advertising Social Media and Drugs
Social Media Platforms
• Growing Use of Internet: 2 billion
people currently access the Internet
and 51% of US users access Internet
for health information
• High traffic-high volume: Facebook
has some 900 million + users, Twitter
250 million +, many of whom visit site
frequently
• Rise in Direct-to-Consumer
Advertising: Legal DTCA has
increased 330% from 1996-2005, twice
as fast as other forms of promotion
Partnership for Safe Medicines
Interchange 2012

3. Direct-to-Consumer Advertising Risks and
Vulnerabilities
Unregulated and Unchecked
• Limited regulation by FDA: FDA has
yet to issue meaningful regulations on
social media DTCA
• Adverse Events: Patients may report
adverse events or provide inaccurate
information to other users
• Others: How to deal with patient
interaction, privacy of PHI, misleading
information about products
• Illicit Activity: Online pharmacies
now heavily populate accessible and
low cost social media
Partnership for Safe Medicines
Interchange 2012

4. Rise of Illicit Digital Health Digital Dangers for Patients
Top 20 DTCA drugs and illicit
social media online pharmacy link
• 90% of Top 10 DTCA
spend drugs have illicit
eDTCA links
• 60% and 50% prevalence
on Facebook among top
10 and top 20 DTCA
advertised drugs
respectfully
• High prevalence of use of
eDTCA 2.0 by illicit online
pharmacies
Liang BA, Mackey TK. Prevalence and Global Health Implications
of Social Media in Direct-to-Consumer Drug Advertising.
J Med Internet Res. 2011 Aug 31;13(3):e64.
Partnership for Safe Medicines
Interchange 2012

5. Rise of Illicit Digital Health Digital Dangers for Patients
Partnership for Safe Medicines
Interchange 2012

6. Rise of Illicit Digital Health Digital Dangers for Patients
Other Risks Include Online availability and safety of drugs in
shortage: a descriptive study of internet vendor
characteristics.
• Drugs that are Currently in Shortage: Liang BA, Mackey TK.
IHLS research shows 94% of identified J Med Internet Res. 2012 Feb 9;14(1):e27.
FDA shortage drugs online Risks of online direct-to-consumer tumor
• Vaccines Online: All FDA Biologic markers for cancer screening.
Drug Shortage list vaccines available Lovett KM, Liang BA, Mackey TK.
J Clin Oncol. 2012 May 1;30(13):1411-4. Epub
online, many WHO EML vaccines 2012 Feb 21
available online
Vaccine shortages and suspect online
• Contraception: All contraceptives pharmacy sellers.
available online, many OTC, with Liang BA, Mackey TK.
YouTube videos showing Vaccine. 2012 Jan 5;30(2):105-8. Epub 2011
administration/use (i.e. IUDs) Nov 15.
• Screening Tests: A number of Suspect online sellers and contraceptive
access.
screening tests, including tumor markers
Liang BA, Mackey TK, Lovett KM.
for cancer available online Contraception. 2012 May 25. [Epub ahead of
print]
Partnership for Safe Medicines
Interchange 2012

7. Research Question Scope and Accessibility of Social
Media
Research Question
•Digital DTCA is Global: Digital DTCA
crosses borders even though it is only
explicitly allowed in the USA and New
Zealand. Illicit actors may engage in digital
marketing.
•Social Media DTCA has Risks: Social
media is high traffic, not limited to
geographical boundaries, is largely
unregulated, and is easily accessible by
questionable users.
•Question: How accessible is illicit online
social media-based pharmaceutical
marketing and does it really go global?
Partnership for Safe Medicines
Interchange 2012

8. IHLS Research Methods and Materials
Social Media Illicit Marketing Risk Assessment
Partnership for Safe Medicines
Interchange 2012

9. IHLS Research Methods and Materials
Social Media IHLS Ad Anatomy
Advertisement for “No Prescription”
and “Safe” Drugs
Fake Seal Advertising “Lowest
Price Promise”
Stock image of “medical
professional” purchased from
website
Picture of various
medicines shot with SRL
at home
Partnership for Safe Medicines
Interchange 2012

10. IHLS Research Methods and Materials
Partnership for Safe Medicines
Interchange 2012

11. IHLS Research Significant Findings
IHLS Research Social Media Websites
• Active: 3 of our 4 illicit online
social media ad sites are still
available
• Traffic: In period of 10 months of
data collection, we generated an
average range of 78-97 unique
user visits (w/out working site)
• Accessibility: Sites were easily
registered under suspect names
(e.g. “no prescription”)
• Low Cost: Total project including
hosting/marketing of $80p/site
Partnership for Safe Medicines
Interchange 2012

12. Research Results Site Links and Stats
Partnership for Safe Medicines
Interchange 2012

13. Research Results Global Scope and High Traffic Countries
Empirical Evidence of Global
Reach
• The United States
ranked highest with
54.3% of total visitors
• Emerging markets,
China and Russia
ranked 2nd (26.0%)
and 4th (6.5%)
respectively
• In total, illicit ads
generated users from
18 diverse countries
Source: Intensity map visualization using Google
Fusion Tables
Partnership for Safe Medicines
Interchange 2012

14. Research Results Unique User Traffic Trends
140
120
100
Facebook
Unique User Traffic
80
Twi er
60
Myspace
40
20
0
ch
l
June
May
July
er
er
er
uary
ber
ary
Apri
b
emb
emb
Mar
Octo
Ja n u
em
Febr
Sept
Nov
Dec
Partnership for Safe Medicines
Interchange 2012

15. Research Results Global User Traffic Trends

16. Research Results Study Limitations
Opportunities for Improvement
• Google+ Suspension: We are not aware
of the reasons for the suspension of our
study site. However, this provides
evidence that suspension/enforcement is
possible from the service provider
• User Types: We did not conduct detailed
examination of user/visitor types (could
include in addition to human users, web
bots, web crawlers, indexing services)
• Relatively Low Traffic: Since we did not
have a working site, we did not generate
significant traffic. This might be due to the
fact that we had a high level of
competition!
Partnership for Safe Medicines
Interchange 2012

17. Research Results Lessons Learned
Summary of Findings Ways Forward…
• Easy: Illicit social media online • Accountability: Make social
pharmacy ads are easy to create, media content providers
even for those in academics! accountable for illicit ads
• Domestic Threats: Highest % of • Surveillance: Content/service
visitors were from USA, consistent providers should easily be able to
with main purchasers of online surveil for questionable
pharmacy products ads/accounts
• Source Countries: Emerging • VIPPS: Possible VIPPS
markets of China and Russia had integration/utilization into social
high % and are known source media sites?
countries for counterfeit drugs
• Cooperation: Enforcement
• It is possible with little experience, requires the cooperation of Internet
expertise or money to create your service sector, regulators and law
own illicit social media online enforcement
pharmacy ad that can go global!
Partnership for Safe Medicines
Interchange 2012

18. Acknowledgments: