program areas Digital Health

This report examines trends in digital marketing to youth that uses "immersive" techniques, social media, behavioral profiling, location targeting and mobile marketing, and neuroscience methods. Recommends principles for regulating inappropriate advertising to youth.

This report describes and provides examples of the types of digital marketing research utilized by the food and beverage industry and the potential effects it has on the health of children and adolescents. Researchers found that food and beverage industry, together with the companies they contract, are conducting three major types of research: 1) testing and deploying new marketing platforms, 2) creating new research methods to probe consumers’ responses to marketing, and 3) developing new means to assess the impact of new digital research on marketers’ profits. Researchers also found that industry puts this research into action, specifically through its efforts to target communities of color and youth.

This letter was sent today to new FTC Chairwoman Edith Ramirez by three-dozen NGOs--including the national leaders in the consumer and privacy fields.

November 23, 2010 - Washington, DC: In a complaint filed today with the Federal Trade Commission, the Center for Digital Democracy, U.S. PIRG, Consumer Watchdog, and the World Privacy Forum called on the commission to investigate unfair and deceptive advertising practices that consumers face as they seek health information and services online. Consumers now confront a sophisticated and largely stealth interactive medical marketing apparatus that has unleashed an arsenal of techniques designed to promote the use of specific brand drugs and influence consumers about treatments for health conditions. Much of the online health marketing system has been deliberately structured to collect personal information and other data on consumers, including through the use of free e-newsletters on specific medical concerns; discounts for prescription drugs and services; and via the growing number of other online data profiling techniques. Nearly $1 billion dollars will be spent this year by online health and medical marketers targeting the growing number of U.S. consumers who increasingly rely on the Internet for information about medical problems, treatments, and prescription drugs. The online marketing health industry has presented to the FDA and the public a fairytale version of digital marketing, where all consumers become empowered “e- patients,” able to form powerful helping communities. But while the online medium provides medical information to those seeking access to resources and support, it has been structured to engage in aggressive tactics that threaten privacy, raise questions about the fair presentation of independent information, and advance the sales of prescription drugs and over-the-counter products. Pharma and other health online marketers are pressing the FDA for new rules that would allow them to expand digital and social media advertising. Before the FDA acts, it should await an investigation and a report by the FTC. The complaint to the Federal Trade Commission is attached.

Washington, DC: The Center for Digital Democracy, in comments filed today with the Food and Drug Administration (FDA), urged the agency to significantly revise its proposed studies on the “Examination of Online Direct-to-Consumer Prescription Drug Promotion.” Citing the wide variety of techniques that pharmaceutical and health marketers use to target consumers online, CDD called for a more informed analysis that reflects how U.S. health consumers are actually marketed to on social networks, mobile phones, and via the Web. Among the marketing techniques that CDD cited that must be part of any FDA research are “the tracking and managing of the ‘patient journey’ online”; data collection; the use of social media analytics and related viral marketing; the role of eye tracking, multivariate testing and other Web page optimization techniques to influence perception and behavior; and the impact of immersive multimedia content and neuromarketing designed to stealthily foster consumer decision-making through non-conscious means. Today is the deadline for comments in FDA’s proposed new research “designed to test different ways of presenting prescription drug risk and benefit information on branded drug Web sites” (Docket No. 2011-N-0230). “While the FDA is to be commended for undertaking additional research before it issues further rules on digital and social media pharmaceutical marketing, we are concerned that the agency—responsible for protecting our health—still has a naïve view of how pharmaceutical digital marketing actually influences consumers,” explained CDD’s Executive Director Jeff Chester. “Online marketing is already an extensive, 360-degree juggernaut that features a wide range of techniques far beyond the scrolling text and banner ads the FDA seems to regard as state of the art. The agency should be in the forefront of ensuring U.S. health consumers have the safeguards they require as they increasingly rely on the Internet and social networks to make decisions about medications and medical treatments.” In its detailed 45-page filing, CDD called on the FDA “to re-conceptualize and update its understanding of digital DTC pharmaceutical marketing,” and pledged its support to assist the agency in expanding its inquiry. CDD urged the FDA to consult with leading independent academic experts and consumer organizations knowledgeable of digital marketing in order to revise its research efforts. CDD’s filing asked the FDA to investigate and develop consumer safeguards for practices used by pharmaceutical and health marketers, including data mining technologies; personalized and behavioral advertising; social media marketing; search engine optimization; rich media and online video applications; mobile and location marketing; unbranded websites; minority and youth marketing; and the use of neuromarketing and other immersive tactics designed to deliberately bypass the rational decision-making process of consumers.

An analysis of the contemporary digital marketing landscape, focusing on the promotion of food & beverage products to youth. Written by Kathryn Montgomery, Ph.D., Sonya Grier, Ph.D, Lori Dorfman, Dr.PH, and Jeff Chester, MSW.This report provides a brief summary of how digital marketing works and the role it plays in promoting unhealthy food and beverages to children. Detailed in the report are key concepts of digital marketing; implications for young people’s health; challenges digital marketing concepts raise for researchers; and relevant theoretical models for understanding how the new digital marketing framework acts on children and youth. Crucial gaps in knowledge and an agenda for future research are also highlighted.

CDD, U.S. PIRG, Consumer Watchdog, and World Privacy Forum call on the Federal Trade Commission to investigate interactive marketing of pharmaceutical and health products and services to consumers and health professionals. Action is required to protect consumers, including their privacy, in the online health and medical marketplace. The FTC has a role to play to help the Food and Drug Administration address new threats. Read the press release below for details…

For the past 25 years, pharmaceutical companies have been permitted to market their products directly to consumers. More recently, in the years following the Food and Drug Administration’s relaxation of direct-to-consumer (DTC) advertising guidelines in 1997, spending on such promotion grew more than six-fold, reaching $5 billion by 2008. In the traditional media of print and broadcast, those DTC ads come with lots of fine print, including warnings of possible side effects that most consumers. But now that ever-increasing amounts of pharmaceutical marketing have moved online, there is another kind of fine print—the truth about invasive and potentially misleading pharmaceutical advertising—that consumers may never see at all. The Center for Digital Democracy recently shared these concerns in a formal filing to the FDA, the highlights of which follow: 1. Personal Data Collection and Privacy Online pharmaceutical and health marketing companies have developed an extensive data collection and interactive targeting apparatus. Few U.S. health consumers are aware that they are being identified, labeled, profiled, and tracked on the Internet while they search or access information on specific conditions or concerns. 2. “Condition” and Behavioral Targeted Advertising Behavioral targeting enables health marketers to stealthily follow consumers online—sometimes across many different websites—gathering details on their interests and activities, and then offering them marketing messages precisely honed to their behaviors related to an illness or condition. Digital marketers employ online “ad networks” to help track and then target individual consumers seeking health-related information. There are also a number of specialized health portals and networks specifically created to target consumers based on particular conditions or concerns. 3. Neuromarketing It should perhaps come as no surprise that many of the companies whose products are rooted in scientific research have turned to neuroscientific techniques in an effort to influence health consumers’ subconscious decision-making processes. Called “neuromarketing,” such techniques are increasingly employed to research, design, and implement online advertising campaigns—including those for health and medical products. NeuroFocus, for example, a firm that specializes in the application of brainwave research to advertising, programming, and messaging, uses “neurological testing [that] delves down to the subconscious mind,” far below such “corrupting factors” as education, language, and cultural variances. Measuring as many as 64-128 sectors of the brain at 2,000 times per second, NeuroFocus promises results that are “unambiguous, accurate, and actionable”—results, we should add, that are achieved without the consumer’s knowledge or consent. 4. Social Media Monitoring and Marketing Perhaps most alarmingly, marketers have developed applications that allow companies to eavesdrop and analyze conversations by and among health consumers, taking advantage of users’ networks of friends to orchestrate peer-to-peer brand promotion. These new surveillance tools monitor conversations among social network users to identify what is being said about a particular issue or product. Marketers then work to insert brand-related messages into the social dialogue, often by identifying and targeting individuals considered brand “loyalists” or “influencers,” and encouraging them to generate buzz through their networks of friends. Increasingly, advertisers are using Facebook’s marketing apparatus—which is largely invisible to its users—to develop a brand presence on its pages so companies can strongly connect to the social communications of a very large pool of consumers. Heartbeat Digital’s BuzzScape, for example “allows clients to monitor discussions that flow in and out of the tens of thousands of message boards, forums, blogs and social networks that increasingly dominate the online environment.” As Heartbeat CEO Bill Drummy admits, “In a sense, we eavesdrop on public conversations among people with a shared interest, then use what we learn to create interactive marketing campaigns that address the identified needs, wants and gaps in knowledge of target audiences.” Perhaps the biggest gap in audience knowledge, of course, is awareness of the fact that online conversations concerning the most sensitive health concerns have become just so much grist for the pharmaceutical marketing mills. 5. Unbranded Sites Another common practice among pharmaceutical companies is the use of online video and websites to raise the awareness of a particular disease or condition—often without clear disclosure of sponsor relationships. Ostensibly designed as educational sites, where individuals can share their experiences with various treatments for certain maladies, sites such as LivingWithEpilepsy.com or ParkinsonsHealth.com are also useful to pharmaceutical companies as a “soft sell” opportunity, free of FDA-mandated risk-disclosure and other advertising requirements. 6. Ad Exchanges These commercial arrangements allow companies to auction off individual users to specific advertisers in real time for ad targeting. Increasingly, the targeting is accompanied by so-called “data optimization,” which draws on various information resources to compile more complete profiles of individual users. For example, Google/DoubleClick’s Ad Exchange Health focus has 36 categories, from Arthritis and Diabetes to Respiratory Conditions and Sleep Disorders. Another advertising network, ADSDAQ, offers 50 health-related categories, from A.D.D. and Alzheimer’s Disease to Weight Loss and Women’s Health. Again, consumers are never apprised of the way their personal data—including intimate health-related information—is being sold to the highest bidder. 7. Audience Segmentation The division of consumers into much smaller affinity groups (e.g., Business Travelers, Sports Fans, Technophiles) for the purpose of targeted marketing is a longstanding advertising practice. Its use by pharmaceutical marketers, however, especially in the digital context, raises a number of critical issues. The segments into which pharmaceutical companies divide their audiences go far beyond demographic and lifestyle categories to include highly personal and sensitive information relating to one’s health. For example, as Mark Miller, senior vice president for healthcare marketer Epsilon, explains, “Segment profiling dimensions include (but are not limited to): market size, geo-demographic characteristics, medication usage, self-care behaviors, bio-metrics, insurance coverage/ usage, needs/attitudes/behaviors and media consumption.” The goal of these data collection and analysis efforts, moreover, is to influence consumer behavior in some of the most personal and profound decisions they will ever have to make, concerning their own and their family’s health. 8. Mobile Campaigns Many of the same consumer data collection, profiling, and behavioral targeting techniques that have raised concerns in the more “traditional” online world have now been brought into the mobile phone marketplace. As U.S. consumers increasingly rely on their mobile devices for a wide range of services, including sensitive transactions related to health, the expansion of behavioral targeting into the mobile world (where it will be combined with precise user and location data) is especially troubling. “Not only does Mobile have a ubiquitous presence—with us 24/7,” boasts Peter Nalen, CEO of Compass Healthcare Communications, “—it can also reach more people, more efficiently, and with greater targetability.” That’s not the kind of personalized service, however, that consumers may want or need in the healthcare arena. And that’s why CDD has called upon the FDA to remedy this situation, first by conducting a comprehensive investigation into the use and impact of digital-health marketing techniques and technologies, and then by working with the Federal Trade Commission and other appropriate agencies to develop a set of policies for regulating the use of behavioral targeting, data collection, and other digital techniques in the marketing of drugs and health-related products.