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With Twitter in flux, pharma is turning to alternative social spaces

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Since Elon Musk took over as CEO of Twitter in October, over 500 of its top advertisers have pulled spending, including some of the biggest pharmas in the world. In fact, companies such as Johnson & Johnson, Pfizer, Roche, AbbVie, Novartis and Merck & Co. didn’t drop a penny on Twitter ads during the first three weeks of the new year, according to data obtained from Pathmatics by Sensor Tower.

The lack of ad spending by pharma giants is likely a result of rising uncertainty about how recent changes on Twitter — such as the discontinuation of its COVID-19 disinformation policy and its new subscription service that allows users to buy verified status — could impact the reputations of companies who operate there.

In particular, the shift has impacted drug developers’ digital strategies for engaging with healthcare practitioners (HCPs) who use Twitter to keep up with the latest medical information. Lately, these HCPs have become increasingly weary of the social media site as Musk’s changes take hold.

And with the digital advertising market booming — the life sciences industry is projected to spend around $18 billion in the area this year and $20 billion in 2024 — companies might not want to wait for the waters to calm on Twitter to resume marketing campaigns targeting HCPs. So where they should spend that money?

Professional headshot of Ethan MacDonald

Ethan MacDonald, social product lead at MedData Group, an IQVIA business

Permission granted by Ethan MacDonald


The timing could be perfect for pharmas to test out underutilized social media sites and double down on strategies for their tried-and-true favorites, said Ethan MacDonald, social product lead at MedData Group, an IQVIA business.

Across industries, 49% of social media advertisers say they are working with more social media brands now than they were at the beginning of 2022. As questions loom over Twitter’s future, the environment is ripe for pharmas to experiment with a more diversified approach to social media, MacDonald said.

Here’s a look at some of the platforms that have emerged as alternatives to Twitter for HCP engagement, along with tips for maximizing their value.


One platform that arose as an early alternative to Twitter in the days following Musk’s acquisition was a little-known site called Mastodon.

Founded in 2016, it has a strikingly similar microblogging infrastructure to Twitter, with a few notable differences. For one, Mastodon is decentralized, meaning that users interact on individual servers focused on a specific topic, instead of on a central feed. It’s also open source, so anyone can download its software, contribute code and modify it.

These few differences to Twitter create new opportunities for companies looking to adopt the platform. Each server, like MedMastodon and NeuroMastodon, has a niche audience network of physicians, and sometimes patients, where pharma companies can provide targeted messages about specific medications.

“You’ve got a community which is enriched for your target audience right there,” said Dr. Nick Mark, a pulmonary and critical care physician at Swedish Medical Center Seattle who created the MedMastodon server.

The downside is there are no paid options available on the platform currently, so all communication with HCPs must be organic. This is likely to change “given the rise in the audience potential,” but is a consideration for any pharma company looking to start using Mastodon right away, said Peter Tromans, manager of regulated strategy at ICUC.

“If you craft your message in the right way, and it catches someone at the right time, there’s always opportunity for communication.”

Ethan MacDonald

Social product lead, MedData Group, an IQVIA business

Another consideration is the content moderation policies on Mastodon. Unlike Twitter, Mastodon servers are run and moderated by individuals on the platform. Some physicians who’ve flocked to Mastodon see this as a positive feature, because it allows them more control over medical misinformation on the site. But Tromans cautions that on some servers, these policies also “leave the potential for disinformation, misinformation, and hate speech to remain unchallenged.”

Because so much is still unknown about Mastodon’s trajectory, Tromans recommended life sciences companies take a “social listening approach” to using the site at first.

“Take a look for content surrounding disease areas and patient communities — it’s where you will most likely find the HCP community dipping their toes into Mastodon,” he suggested. “Patient communities thrive throughout social media, and HCPs are sure to be searching for them.”

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