Consumers may still see a barrage of ads featuring healthy, happy people and pronouncements of "Ask your doctor about" prescription so-and-so on television, but pharmaceutical marketing is quietly moving its investment out of this medium. Companies are dipping their toes into the bustling Internet, trying to gain a foothold in the rapidly expanding online social media.

In February, Sanofi-Aventis launched a YouTube channel, "Go Insulin," consisting of informational videos and patients' personal testimonials about type 2 diabetes and insulin treatment, but it does not provide direct promotional content for the insulin products the company manufactures. AstraZeneca has also launched a YouTube channel, titled" My Asthma Story," to promote its asthma drug with videos and patient testimonials. Interestingly, neither companies' names are featured prominently on these video Web sites. The AstraZeneca site was identified as only "Brought to you by the maker of Symbicort."

These YouTube-based marketing campaigns followed those of several other companies, including Johnson and Johnson and GlaxoSmithKline, which started their branded channels on YouTube in 2008.

YouTube is far from the only forum for online direct-to-consumer (DTC) advertising. Companies have long used product-specific Web sites to disseminate information about specific medications and devices to consumers and health care professionals. However, online social networks such as YouTube, FaceBook, and MySpace are drastically changing the ways people and groups connect with each other. Messages are transmitted laterally through the Web, rather than vertically, from the originator to the end user, and rely heavily on word of mouth for a successful message campaign.

In recent years television DTC advertisements have been accused of false representation and have drawn increasing criticism from lawmakers and consumer-advocacy groups (Psychiatric News, January 16). Even industry insiders began to question the viability of traditional DTC marketing.

The online media provide a far less expensive, more flexible, and more interactive playing field for marketers than do broadcast television and other traditional media. For example, YouTube channels can encourage patients to submit their own testimonial videos that cost nothing to produce and appear authentic. These advantages make online multimedia advertisements attractive to manufacturers at a time when DTC marketing budgets remain flat or decline in the current economic climate.

However, the return on investment can be much more unpredictable. In the vast and rapidly morphing online world, how to grab and hold the attention of fickle users is still the biggest challenge and one that still leaves marketers scratching their heads.

Regulating promotions of medications in the new media poses new challenges. The Food and Drug Administration (FDA) Division of Drug Marketing, Advertising, and Communications (DDMAC) is in charge of regulating all marketing and promotional activities of pharmaceutical and medical-device companies. In 2008, for example, the DDMAC sent a warning letter to Shire regarding a YouTube video for Adderall XR featuring celebrity Ty Pennington that "overstate[d] the efficacy of Adderall XR" and" omit[ted] important information regarding the risks associated with" the drug. Shire withdrew the video.

"DDMAC has been and continues to monitor the many vehicles that companies use to promote their prescription drug products... including magazine ads, TV ads, promotional exhibits at medical conferences, Internet...," Karen Mahoney, an FDA spokesperson told Psychiatric News. "Internet monitoring includes promotion done by or on behalf of drug companies such as on companies' own product Web sites and their placement of promotion on others' Web sites." She pointed to the FDA's actions on the Shire YouTube video as an example of the agency's effort to monitor such promotions. ▪