NoFocus from FDA on social media -- and it's about time!

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  • 06/17/2014

Per FDASIA: By July 9, 2014, FDA must issue guidance describing FDA policy regarding Internet promotion, including social media, of medical products regulated by FDA.

Well, ahead of schedule we now have two draft guidances:

Guidance for Industry Internet/Social Media Platforms with Character Space Limitations — Presenting Risk and Benefit Information for Prescription Drugs and Medical Devices


Guidance for Industry Internet/Social Media Platforms: Correcting Independent Third-Party Misinformation About Prescription Drugs and Medical Devices

First let’s discuss “Social Media Platforms with Character Space Limitations.

Perhaps the biggest leap forward for the agency is that is beginning to differentiate between social media platforms, recognizing that different rules must apply for different types of platforms. Obviously, when it comes to platforms such as Twitter the main issue is character limitations. The agency also points out that the same is true for advertising venues such as banner ads on Google (shades of the FDA’s first batch of warning letters from 2009).

So, to the FDA’s credit, it only took the agency about five years to develop draft guidance. Not a badge of honor.

Still, there are some interesting things to be gleaned from the draft guidance. The agency writes:

Risk information should be comparable in content and prominence to benefit claims within the product promotion (i.e., a balanced presentation). Achieving a balanced presentation requires firms to carefully consider the desired benefit claims and risk profiles for their products when choosing a promotional platform.

That’s good advice – choose the platform that best suits any given communications need. But, it’s not really any communications need – it’s any promotional program. That’s important because promotional speech is regulated speech. And that’s not just regulatory rhetoric. And this begs a crucial question not covered in the draft guidance – What it the intent of the communications?

Don’t wait for the FDA to offer guidance on that. They will not and should not. That’s a question only the communicator can answer. And it needs to be done honestly and early in the communications development process.

The agency writes:

FDA acknowledges that Internet/social media platforms associated with character space limitations may pose challenges for firms in providing a balanced presentation of both risks and benefits of medical products, as discussed above … The firm should also provide a mechanism to allow direct access to a more complete discussion of the risks associated with its product.

In a likely unintended nod to self-deprecation, the agency offers potential examples of how this could be done for the fictitious product NoFocus.

The agency writes:

A firm is considering promotion of its prescription drug NoFocus on Twitter …  NoFocus is indicated for mild to moderate memory loss.

The draft guidance suggests that the tweet contain the following 40 characters:

NoFocus for mild to moderate memory loss

The agency writes:

The benefit information for NoFocus that is communicated within the first 40 character spaces of this tweet is accurate and non-misleading and includesmaterial facts about the indication and limitations to the use of NoFocus.

So, the agency is also suggesting that these 40 characters be the first 40.

The agency then proceeds to discuss paid search advertising for the fictitious product Headhurtz. (This is likely the product in development for legal and regulatory review departments at pharmaceutical and medical device companies.)

The agency suggests that information on limitations and appropriate use as well as a link to the product website be included. Specifically:

Headhurtz [] For severe headache from traumatic brain injury

It’s not Brief Summary, it’s Tweet Summary.

The agency’s most important advice appears on Page 12 of the draft guidance:

In communicating risk information on Internet/social media platforms with character space limitations, firms should consider the following points:

1. Risk information should be presented together with benefit information within each individual character-space-limited communication (e.g., each individual message or tweet).

2. The content of risk information presented within each individual character - space-limited communication should, at a minimum, include the most serious risks associated with the product.

3. A mechanism, such as a hyperlink, should also be provided within each individual character-space-limited communication to allow direct access to a more complete discussion of risk information about the product … the Agency recommends that a direct hyperlink to a landing page that is devoted exclusively to comprehensive risk information about the product be initially included within the original character-space-limited communication.

Not rocket science, but urgently important to remember when considering both the design and appropriateness of a limited-character platform. Also, the use of hyperlinks is crucial – and will be even more so as we move on to a discussion of the second of the agency’s newly minted draft guidances. (Note – the agency makes it clear that a link’s name should also be considered. Specifically, it shouldn’t be a claim (i.e.,

Per the new “Tweet Summary,” the agency writes:

Since benefit information was provided within the tweet (example 1A), the firm should communicate, at a minimum, the most serious risks associated with NoFocus within the same tweet. The firm should also include within the same tweet a direct hyperlink to a more complete discussion of risk information about NoFocus. Additionally, the prominence of risk information should be comparable to the benefit information contained within the tweet, taking into consideration any formatting capabilities that may be available. The firm considers including the following benefit and risk information within the tweet:

NoFocus for mild to moderate memory loss; may cause seizures in patients with a seizure disorder

And, as a further build:

… the firm should also communicate the brand and established names within the tweet. The firm considers including the following product information, together with benefit and risk information about NoFocus, within the tweet:

NoFocus (rememberine HCl) for mild to moderate memory loss-May cause seizures in patients with a seizure disorder

As it turns out, the Tweet Summary takes up quite a bit of the available characters – and this is for a non-Black Box product. For those of you keeping count, it’s now up to 134 characters – leaving only six characters for Hi Mom.

Later on Pages 12-13 the agency spells out how verbiage and hyperlinks can be compliantly used for promotional speech such as sponsored Google links. Its well a well thought out and developed template. And it’s more restrictive – as it should be. After all, there are rules for advertising. Five years in the making. Headhurtz indeed!

Now let’s move on to a far more important public health issue: Correcting Independent Third-Party Misinformation About Prescription Drugs and Medical Devices.

For those of you not currently on NoFocus therapy, you will remember the 2009 Part 15 hearing on social media – the “SuperBowl of FDA Part 15 hearings.” One of the key questions the agency wanted to discuss was how to correct erroneous product information. All they got were blank stares and request for FDA guidance. Five years later – voila!

The agency writes:

This draft guidance is intended to describe FDA’s current thinking about how manufacturers, packers, and distributors (firms) of prescription human and animal drugs (drugs) and medical devices for human use (devices) should respond, if they choose to respond, to misinformation related to a firm’s own FDA-approved or -cleared products when that information is created or disseminated by independent third parties on the Internet or through social media or other technological venues (Internet/social media), regardless of whether that misinformation appears on a firm’s own forum or an independent third-party forum or website.

Key take-away is that the decision to correct errors is purely voluntary. (But, then again, technically so are all product recalls.) Where that becomes more complicated is how companies may choose to cherry-pick where they interceded for corrective purposes. This is not an issue addressed by the FDA in this draft guidance.  One thing this all means is more work for legal and regulatory review.

This draft guidance is all about user-generated content. The agency writes:

The Internet and Internet-based technologies have made it easier for third parties who are independent of firms to disseminate information about drugs and devices. Information created by third parties (which for purposes of this guidance is user-generated content (UGC)) might appear on an interactive portion of a firm controlled website or other interactive Internet/social media platform, or information might appear on a website or other Internet/social media platform that is independent of, or not under the control or influence of, a firm.

Many Internet/social media platforms allow for real-time and continuous communications and interactions (e.g., blogs, microblogs, social networks, online communities, and live podcasts) while other platforms do not provide a means for interactive content to be posted. Whether a forum is interactive may affect the means by which a firm is able to respond to information.

And, the agency stipulates, “UGC might not always be accurate and may be dangerous or harmful to the public health.” Well, yes. What’s a manufacturer to do?

Five years later, some helpful advice from the good people at White Oak.


If a firm voluntarily corrects misinformation in a truthful and non-misleading manner and as described in this draft guidance, FDA does not intend to object if the corrective information voluntarily provided by the firm does not satisfy otherwise applicable regulatory requirements regarding labeling or advertising, if any.

From a regulatory perspective, that’s a lot of wiggle room and should provide significant food for thought in erring on the side of more rather than fewer voluntary corrective actions.


If a firm chooses to respond to misinformation about its products using non-truthful or misleading information or in a manner other than that recommended in this draft guidance, however, FDA may object if the information provided by the firm does not comply with applicable regulatory requirements related to labeling or advertising, if any.

Certainly. But what this also harkens back to is the agency’s previous guidance where it warns against using company-generated (sponsored) UGC relative to other companies’ products. That 12/11 guidance warns:

If a firm chooses to respond to public unsolicited requests for off-label information, the firm should respond only when the request pertains specifically to its own named product (and is not solely about a competitor's product).

Forewarned is Forearmed. Don’t get to cute.

This draft guidance isn’t about sponsored communications. The agency writes:

This draft guidance does not apply when a firm is responsible for the product communication that contains misinformation. A firm is responsible for communications that are owned, controlled, created, or influenced, or affirmatively adopted or endorsed, by, or on behalf of, the firm.

A firm is thus responsible for communications on the Internet and Internet-based platforms, such as social media, made by its employees or any agents acting on behalf of the firm to promote the firm’s product, and these communications must comply with any applicable regulatory requirements.


… this draft guidance applies when a firm is not responsible for a product-related communication that appears on the firm’s own forum, an independent third- party website, or through social media, and the firm chooses to correct misinformation about its own product contained in that communication. In such cases, we recommend that the firm do so as described in this draft guidance.

More detail is provided here relative to the nuance of “control” and “sponsorship (pages 7-8) and are worth reading.

Here are the agency’s eight ground-rules for “appropriate corrective information;”

* Be relevant and responsive to the misinformation;

* Be limited and tailored to the misinformation;

* Be non-promotional in nature, tone, and presentation;

* Be accurate;

* Be consistent with the FDA-required labeling for the product;

* Be supported by sufficient evidence, including substantial evidence, when appropriate, for prescription drugs;

* Either be posted in conjunction with the misinformation in the same area or forum (if posted directly to the forum by the firm), or should reference the misinformation and be intended to be posted in conjunction with the misinformation (if provided to the forum operator or author);

* Disclose that the person providing the corrective information is affiliated with the firm that manufactures, packs, or distributes the product.

Truthful. Accurate. Transparent. Three good rules of thumb. But what about “timeliness?” No advice from the agency on this one – but something crucial for manufacturers to consider since the goal here is to protect the public health.

Again, the agency offers important nuance on how to correct. For example, don’t just correct one mistake when multiples ones appear. The draft guidance also offers absolutely critical commentary relative to the depth and breadth of responsibility when correcting one piece non-sponsored UGC, “The firm is not expected to correct misinformation that appears on other webpages of the website.”

Those sweet sixteen words address a world regulatory angst.


Once a firm undertakes the correction of misinformation, FDA does not expect the firm to continue to monitor the website or communication that previously included UGC containing misinformation.

This does, however, point to the need for individual companies to develop their own policies in this regard. More work for legal/regulatory review teams!

And, for those of you who are thinking a little too hard, consider this important caveat:

… if a firm chooses to correct only misinformation that portrays its product in a negative light in a third-party communication but does not address misinformation that overstates the benefits of its product in that same clearly defined portion of the communication, the firm’s actions do not meet the recommendations in this draft guidance.

Voluntary corrective action isn’t just about “bad” information.

And, importantly:

FDA recognizes that a firm cannot control whether an independent third party refuses to correct the misinformation, or corrects only a portion of the misinformation even though the firm provided complete corrective information, or declines to include the respective required labeling, or declines to remove misinformation, or does not correct all the misinformation in one clearly defined part (if the firm sought to correct more than one piece of misinformation). Accordingly, FDA will not hold a firm accountable for an independent third party’s subsequent actions or lack thereof.

The perfect shall not impede the public good.

And, lastly:

FDA does not expect firms to submit corrections to the Agency when correcting misinformation pursuant to this draft guidance; however, FDA recommends that firms keep records to assist in responding to questions that may come from the Agency. The records should include, for example, the content of the misinformation, where it appeared, the date it appeared or was located, the corrective information that was provided, and the date the corrective information was provided.

Good guidance has been provided. Now it’s time for industry to do the right thing.


Center for Medicine in the Public Interest is a nonprofit, non-partisan organization promoting innovative solutions that advance medical progress, reduce health disparities, extend life and make health care more affordable, preventive and patient-centered. CMPI also provides the public, policymakers and the media a reliable source of independent scientific analysis on issues ranging from personalized medicine, food and drug safety, health care reform and comparative effectiveness.

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