NM Incite’s Melissa Davies (Strategic Account Director, Healthcare) presented a webinar with the American Marketing Association on Healthcare Social Media. As part of the presentation, Melissa shared some new benchmarking data related to online conversations within the healthcare space. “We have always looked at total volume of online discussion, and that is still important,” Melissa said. “But we are also looking at new ways to understand engagement with social media and how that differs across therapeutic areas. Our new data plots the volume of online discussion against disease prevalence as one way to measure that engagement.”

1. Melissa Davies Strategic Accounts Director, Healthcare April 20, 2011 Healthcare Social Media The Conversation That Is Defining Your Brand

2. Introducing NM Incite Trusted data provider, leveraging proprietary technology and buzz sources from 160+ million social media sites – across Twitter, Facebook, blogs, message boards, and customer reviews Global reach, in 18 countries (and growing) Access to Nielsen’s proprietary consumer panels for online, TV, and retail purchases Benchmarks and insights from over 150 clients, especially in health care, CPG, retail, auto, CE, Financial services Market leader in enterprise social media monitoring/ analytics (Source: Forrester) Industry-leading expertise in digital marketing, product development, and service operations Capability-buildinginitiatives to enable incorporation of social media into core organizational processes Functional expertise in translating social media metrics and insights into action and sustained improvement

3. Social media and health Getting Started 3

4. Social Networks Micro- blogs Reviews Social Media Media Sharing Blogs Discussion Forums Social Gaming Defining the social media landscape Create personal profiles to facilitate keeping in touch, meeting new people, and sharing key interests Sign up for a personal feed to broadcast activities and receive real-time updates (e.g., news, friends, celebrities) Evaluate and rate products and services based on personal experience Upload, share and comment on photos, videos and audio to facilitate mass distribution of rich media Create individual blog to discuss opinions, and experiences based on daily life Register for communities to discuss specific topics, seek advice / discuss mutual interests Connect with friends / individuals to play and discuss popular games in the online space 4

5. Social media outpaces all other online activities SOURCE: Nielsen NetView, June 2010 *Other refers to 74 remaining online categories visited from PC/laptops. **NetView’s Video/Movies category refers to time spent on video-specific (e.g., YouTube, Bing Videos, Hulu) and movie-related websites (e.g., IMDB, MSN Movies and Netflix) only. It is not a measure of video streaming or inclusive of video streaming on non-video-specific or movie-specific websites (e.g., streamed video on sports or news sites). 5

6. Even Grandma is on Facebook % of Adult Internet Users Who Use Social Networking Sites Social networking use among internet users ages 50 and older has nearly doubled – from 22% to 42% over the past year SOURCE: Pew Research Center 6

7. Online health-seeking continues to grow Eight in ten internet users look online for health information, making it the third most popular online activity among all those included in the Pew Internet Project’s surveys. SOURCE: Pew Research Center’s Internet & American Life Project surveys, 2008-2010 7 7

8. Where do today’s consumers get health information? 8

10. “Cyberchondriacs” on the rise 86% were satisfied with their ability to find the information they want online 81% of all Cyberchondriacs have looked for health information online in the last month 85% believe the information they found is reliable 17% have gone online to look for health information 10 or more times in the last month SOURCE: The Harris Poll, Harris Interactive

11. Mobile is changing internet use Trend to Watch 11

12. Explosion of mobile is well documented 14% of mobile subscribers have downloaded an app in the last 30 days Mobile phones will overtake PCs by 2015 A typical U.S. mobile subscriber sends and receives 175% more text messages than voice calls SOURCES: Nielsen, Nielsen Mobile 12

13. Mobile internet use is increasing % of all adult cell owners who do the following on their phones (2010) One-year change in use of cell phones to access the Internet:+52% SOURCE: Pew Research Center's Internet & American Life Project, 2010

14. Who is more likely to use the mobile web? Younger Groups (no surprise) Minorities SOURCE: Pew Research Center's Internet & American Life Project, 2010

15. Mobile increases web, social utilization Facebook Mobile Users People who use Facebook on their mobile devices are twice as active on Facebook as non-mobile users SOURCES: Facebook.com, AllFacebook.com, InsideFacebook.com

16. Four lessons from healthcare social media 16

17. Which conditions drive most active online discussion? 17 Lesson 1

18. Discussion volume by condition 18

19. Fibromyalgia Cardiovascular Disease Depression Hypertension ADHD Breast Cancer Hodgkin’s Lymphoma Non-Hodgkin’s Lymphoma Ovarian Cancer Bipolar Disorder Gout Type 1 Diabetes Colorectal Cancer Brain Cancer Multiple Sclerosis COPD Cystic Fibrosis Schizophrenia Ulcerative Colitis Type 2 Diabetes Rheumatoid Arthritis Arthritis Key: Cardiovascular Chronic Condition Mental Health Oncology Pain Alzheimer’s Disease

21. Highly patient-driven

23. Caregivers are more active

24. Very highly engagedSOURCES: Cancer prevalence data: US National Cancer Institute's Surveillance Epidemiology and End Results (SEER), 2007. Buzz is measured across NM Incite’s Healthcare dataset, 1/1/2010-12/31/2010.

25. 671,507 messages Oncology: buzz vs. prevalence Ratio of Messages:Prevalence Discussion Volume 10,205 messages Hodgkin’s Lymphoma 18,024 messages Non-Hodgkin’s Lymphoma 31,710 messages Ovarian Cancer Colorectal Cancer 56,508 messages Brain Cancer 63,649 messages Breast Cancer SOURCES: Cancer prevalence data: US National Cancer Institute's Surveillance Epidemiology and End Results (SEER), 2007. Buzz is measured across NM Incite’s Healthcare dataset, 1/1/2010-12/31/2010.

26. Mental health: buzz vs. prevalence 73,069 messages Ratio of Messages:Prevalence Discussion Volume 414,813 messages Bipolar Disorder 208,892 messages Alzheimer’s Disease 191,499 messages ADHD 497,442 messages Depression Schizophrenia SOURCES: Prevalence data: Alzheimer’s Association, National Health Interview Survey 2009, National Institutes of Mental Health. Buzz is measured across NM Incite’s Healthcare dataset, 1/1/2010-12/31/2010.

27. Chronic: buzz vs. prevalence Ratio of Messages:Prevalence Discussion Volume 45,419 messages 66,772 messages 85,346 messages 117,376 messages Cystic Fibrosis 2.845 56,203 messages Multiple Sclerosis Type 1 Diabetes Type 2 Diabetes COPD SOURCES: Prevalence data: NIAID, NWHIC, Cleveland Clinic, National Heart Lung and Blood Institute, Cystic Fibrosis Foundation. Buzz is measured across NM Incite’s Healthcare dataset, 1/1/2010-12/31/2010.

28. Sampling the conversation Brain Cancer “Brain cancer is so awful. My mom is still in treatment, she has about 10 more avastin treatments left. She is 72, somewhat weak, hardly talks because she can't think of the right word to say and does nothing but sit in a chair all day and look out the window. I wonder what will happen once treatment ends, will she get any better or can we expect more of the same for the rest of her life.” CancerCompass.com, 2011-01-13 Breast Cancer “I can related to the emotions impact of breast cancer you are feeling , I was shocked, scared, angry, overwhelmed , crushed , hopeless, when the doctors informed me … in order for me to survive this I had to take life with cancer one day at a time , surrounded myself with family, friends , prayer and faith . … you are not along in this fight , I will keep you and your family in my prayers.” National Breast Cancer Foundation Forums, 2011-01-29

29. Implications How active/important is social media for my therapeutic area? Online advertising spend Market research approach Social media engagement (branded/unbranded) 25

30. What information is shared online? Lesson 2 26

31. Discussion is broad-ranging Emotional support Doctor-patient interaction Personal Experience Treatment options Symptoms Management strategies Brand-specific discussion ~20%

32. Buzz snapshot: type 2 diabetes Source: NM Incite analysis of Type 2 Diabetes discussion 1/2011. Word cloud image created using Wordle.net

33. Online currency: personal experience "My own personal experiance has been good. I started Onglyza in late January and I still inject Lantus daily 23-25 units and take one 5mg Onglyza. For the first few months I was able to cut the Novalog to an occasional correction and for the last month or so haven't even needed to do that. My BG average since starting is 109 with 98% of my numbers ranging 151-67. For the last 5 weeks my average has dropped to 101 with most readings falling between 70 and 130. 8 months ago my A1c was over 10, late January it was 8. 6, my next A1c is in early August and I expect to see somewhere around 5. 5." Tudiabetes.org, 2010-06-05 Treatment regimen, dosage Personal experience Monitoring health “by the numbers”

34. Positive and negative are shared "I want to go off the met. . . tummy issues and have been on it since November 2 x 5oo mg xr 2 x a day. . thats a lot of met plus the onglyza which does nothing as far as I can tell. Still need to lose about another 20 lbs. . . am 5'2'' and 148 lbs. Loved the effects of the victoza on weight but not the constant nausea. Had been on duetact for a while. . but kept going hypo. Then Glymepiride. . made me hungry as all get out. Sheesh. . . . am so sick and tired of the whole thing!!!!" Diabetesforum.com, 2010-05-21 Side effects Lack of efficacy General frustration with treatment history

35. Internet as second opinion "My Dr. just prescribed onglyza. I did a text search of the group but haven't seen it mentioned. Does anybody have any knowledge on this newly approved drug?" Yahoo! Groups: type-2-diabetes, 2010-01-30 Looking for more information "Onglyza Is anyone taking this? Hubby was prescribed it today and I see that it hasn't been out very long. Does anyone know anything about it?" Diabetesforums.com, 2010-02-26 Caregiver involvement "Has anyone heard anything about onglyza? I saw a commercial for it yesterday and was wondering if it could be used with Byetta?" Yahoo! Groups: diabetes_and_byetta, 2010-06-07 Treatment combination

36. Implications What is patient lexicon surrounding this condition? Language that will best connect with patients Marketing Patient/physician education materials How do patients feel about my brand? Understand frustrations, challenges, needs Do we need to do a better job of setting patient expectations? Patient education materials Package insert, branded collateral Physician communication 32

37. Who takes part in the discussion? Lesson 3 33

38. Patients drive online discussion Share of Discussion Contributed by Patient/Caregiver/HCP, by Condition SOURCE: NM Incite analysis; speaker demographics are qualitatively assessed.

39. Implications Who can we hear through social media channels? Market research approach Who can we reach through social media channels? How should we tailor the message to the audience? Marketing spend allocation Planning for online engagement 35

40. What happens when a brand is in crisis? Lesson 4 36

41. Brand crises drive buzz Trended Buzz for JNJ and Recall (Weekly) Children's Benadryl, Motrin, Rolaids, Nov. 2010 Infant & Children's Products, April 30, 2010 Rolaids Softchews, Dec. 9, 2010 Tylenol and other products, January 14, 2011 Tylenol, Benadryl & Motrin, July 8, 2010 Tylenol 8 Hour, Oct. 18, 2010 Tylenol, Benadryl, June 15, 2010 Children’s Tylenol, Sept. 24, 2009 Zyrtec, Motrin &Tylenol, March 2010 Tylenol Arthritis, Nov./Dec. 2009 McNeil, Jan. 2010 37

43. Day 3: Deeper dive: Which brands are recalled, why, what parents should do

44. Day 6: Congressional panel investigates recallInfant & Children's Products Recall, April 30 One-day change in buzz: +1740%

45. What do consumers share? “Get generic or go with a different brand (PediaCare Fever/acetaminophen or Infant Advil/Ibuprofen). … The FDA report on the only factory that makes infant Tylenol/Motrin is absolutely DISGUSTING- so many horrible violations, gram negative bacteria in ingredients used in lots of medications for BABIES! Don't expect to see "safe" Tylenol or Motrin on shelves for a looong time. I will never, EVER support that company again, if I can avoid it- and I can certainly avoid supporting them through these meds, as there are non-McNeil generics and brand names available.” TheBump.com, 2010-05-07 Frustration with the company

46. What do consumers share? “Friday Freakout: Tylenocalypse Edition We left town early, and so we at least saved our own weekend from the gigantic )#($%ingfreakout that is the massive recall of liquid infant's and children's Tylenol, Motrin, Zyrtec, and Benadryl products issued Saturday. Wait, Saturday? What the hell kind of government agency issues a sweeping recall of some of the most popular children's medicines on a Saturday? … That would be the FDA. This is not the first time the FDA has had ineffective, hard-to-follow recall announcements; I hope someone's trying to fix that place.” DaddyTypes.com, 2010-05-03 Frustration with the recall process

47. Implications How quickly does crisis news spread among consumers? What are patients and caregivers saying about the event? What information sources are they sharing? How does consumer opinion about the brand change as a result? 41

48. Questions? Thank you! Melissa Davies Strategic Accounts Director, Healthcare Melissa.Davies@nmincite.com @MelissaKDavies 42