*Timothy Ken Mackey
University of California, San Diego
Oral Presentation – Research Track
Saturday, Sept 29, 2012: 10:05 AM – 10:25 AM – LK130

*Presenting Speaker

Background

Previous studies have identified direct-to-consumer drug product marketing using online interactive social media technologies (eDTCA 2.0) by illicit online pharmacies. This form of fraudulent Internet advertising presents unique threats to patient safety and public health that have yet to be addressed through effective regulation. Hence, in the context of massive and rapid social media expansion, a key question is: how hard is it to create illicit online pharmacies and attract customers using social media formats?

Methods
The purpose of this study was to assess the accessibility and creation of illicit eDTCA 2.0.We first identified the top 4 social media platforms by user traffic volume allowing eDTCA 2.0. (i.e. Facebook, Twitter, Google+, Myspace). We then created a fictitious advertisement that marketed “no prescription” drugs online. The advertisement was posted on a weekly basis using the identified social media platforms. Each advertisement linked to a unique website URL that consisted of a “site error” rather than an illicit online pharmacy. Employing web analytics, we then tracked the number of users visiting these sites and the location of users using IP addresses. This project was approved by an Institutional Review Board.

Results
Identified social media platforms Facebook, Twitter and Myspace that we created remained accessible despite highly questionable and potentially illegal content. Only our Google+ site was suspended by the service provider for undisclosed reasons. Fictitious advertisements promoting illicit sale of drugs generated user traffic of 20-170 visits per month per site (based on social media type) over a 6 month period. This level was achieved despite absence of search engine optimization, search engine marketing, and a functional site actually selling product—standard business analytics and web marketing approaches to maximize online presence. Further, we found that our websites were accessed by users in a number of countries, including not only high-income countries, but also emerging markets, EU Accession countries, and developing countries.

Conclusions
Illicit online drug sellers represent a global public health and patient safety risk that remains unaddressed. The results of this study show there are few barriers to entry into the illicit online pharmacy trade through creation of illicit marketing and high traffic social media outlets.  Indeed, this research provides the first, direct evidence of the globalization of this illicit social media marketing to countries outside the USA. Beyond safety concerns and violation of legal rules regarding online pharmacies, this is further troubling because direct-to-consumer advertising of medical products is generally illegal in virtually all other countries other than the USA and New Zealand. Patients, regulators, policymakers, Internet service providers and the broader general public need to be aware of the risks associated with these activities.