A Day In the Life of Illegal Online Drug Sellers Using Social Media by Tim Mackey, Alsberg Fellow

PSM Original Research:A Day in the Life of Illegal Online Drug Sellers Using Social Media

Timothy Ken Mackey, MAS

IHLS Senior Research Associate

PSM Carl L. Alsberg Fellow ©2012

Direct-to-Consumer AdvertisingSocial Media and Drugs

• 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

Social Media Platforms

Partnership for Safe Medicines Interchange

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Direct-to-Consumer AdvertisingRisks and Vulnerabilities

• 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

Unregulated and Unchecked


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Rise of Illicit Digital HealthDigital Dangers for Patients

• 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

Top 20 DTCA drugs and illicit social media online pharmacy link

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.


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• Drugs that are Currently in Shortage: IHLS research shows 94% of identified FDA shortage drugs online

• Vaccines Online: All FDA Biologic Drug Shortage list vaccines available online, many WHO EML vaccines available online

• Contraception: All contraceptives available online, many OTC, with YouTube videos showing administration/use (i.e. IUDs)

• Screening Tests: A number of screening tests, including tumor markers for cancer available online

Other Risks Include

Suspect online sellers and contraceptive access.Liang BA, Mackey TK, Lovett KM.Contraception. 2012 May 25. [Epub ahead of print]

Vaccine shortages and suspect online pharmacy sellers.Liang BA, Mackey TK.Vaccine. 2012 Jan 5;30(2):105-8. Epub 2011 Nov 15.

Risks of online direct-to-consumer tumor markers for cancer screening.Lovett KM, Liang BA, Mackey TK.J Clin Oncol. 2012 May 1;30(13):1411-4. Epub 2012 Feb 21

Online availability and safety of drugs in shortage: a descriptive study of internet vendor characteristics.Liang BA, Mackey TK.J Med Internet Res. 2012 Feb 9;14(1):e27.


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Research QuestionScope 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?


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IHLS Research Methods and Materials

Social Media Illicit Marketing Risk Assessment


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Social Media IHLS Ad Anatomy

Fake Seal Advertising “Lowest Price Promise”

Fake Seal Advertising “Lowest Price Promise”

Advertisement for “No Prescription” and “Safe” Drugs

Advertisement for “No Prescription” and “Safe” Drugs

Picture of various medicines shot with SRL

at home

Picture of various medicines shot with SRL

at home

Stock image of “medical professional” purchased from

website

Stock image of “medical professional” purchased from

website


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IHLS Research Significant Findings

• 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

IHLS Research Social Media Websites


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Research Results Site Links and Stats


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• 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

Empirical Evidence of Global Reach

Research Results Global Scope and High Traffic Countries

Source: Intensity map visualization using Google Fusion Tables


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Research Results Unique User Traffic Trends


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Research Results Global User Traffic Trends

• 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!

Opportunities for Improvement

Research Results Study Limitations


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• Easy: Illicit social media online pharmacy ads are easy to create, even for those in academics!

• Domestic Threats: Highest % of visitors were from USA, consistent with main purchasers of online pharmacy products

• Source Countries: Emerging markets of China and Russia had high % and are known source countries for counterfeit drugs

• It is possible with little experience, expertise or money to create your own illicit social media online pharmacy ad that can go global!

Summary of Findings

Research Results Lessons Learned

• Accountability: Make social media content providers accountable for illicit ads

• Surveillance: Content/service providers should easily be able to surveil for questionable ads/accounts

• VIPPS: Possible VIPPS integration/utilization into social media sites?

• Cooperation: Enforcement requires the cooperation of Internet service sector, regulators and law enforcement

Ways Forward…


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Acknowledgments:

Business

A Day In the Life of Illegal Online Drug Sellers Using Social Media by Tim Mackey, Alsberg Fellow