AUTH/3038/4/18 - Health professional v Novartis

Conduct of an employee on LinkedIn

  • Received
    25 April 2018
  • Case number
    AUTH/3038/4/18
  • Applicable Code year
    2016
  • Completed
    05 December 2018
  • No breach Clause(s)
  • Breach Clause(s)
  • Sanctions applied
    Undertaking received
  • Additional sanctions
  • Appeal
    No appeal
  • Review
    Published in the May 2019 Review

Case Summary

An anonymous contactable complainant who described themselves as a concerned UK health professional complained about a named Novartis employee using LinkedIn to promote medicines.  The medicines at issue were Entresto (sacubitril/ valsartan) used in adults with chronic heart failure, and Cosentyx (secukinumab) used in adults with moderate to severe plaque psoriasis. 

The complainant noted that he/she had received information on LinkedIn that had been shared (‘liked’ posts) and considered it inappropriate for company employees to use LinkedIn to promote information, including studies, about their companies’ products.  It was promotion to nonprescribers and the complainant doubted that the materials shared had undergone appropriate internal review.  The material at issue included: an article which discussed the prescribing behaviour of cardiologists and how to price new medicines in relation to the Entresto launch; Vivinda TV which appeared to be a resource solely intended for health professionals but was being advertised to the public; and advertising of a Novartis press release regarding Phase III data for Cosentyx.

The detailed response from Novartis is given below.

The Panel noted that the complaint concerned LinkedIn activity on an employee’s personal LinkedIn account.  In the Panel’s view, it was of course not unacceptable for company employees to use personal LinkedIn accounts and the Code would not automatically apply to all activity on a personal account; if activity was found to be within the scope of the Code, the company would be held responsible. 

The Panel noted that material could be disseminated or highlighted by an individual on LinkedIn in a number of ways including posting, sharing, commenting or liking.  The algorithms applied by LinkedIn were relevant including whether an individual could opt out of material being disseminated by such algorithms.  In the Panel’s view, activity conducted on social media that could potentially alert one’s connections to the activity might be considered proactive dissemination of material.  In addition an individual’s activity and associated content might appear in the individual’s list of activities on his/her LinkedIn profile page which was visible to his/her connections; an individual’s profile page was also potentially visible to others outside his/her network depending on the individual’s security settings. 

The Panel noted that the complaint concerned three specific activities:

1            Sharing an article on the prescribing behaviour of cardiologists and how to price new medicines in relation to the Entresto launch

The Panel noted Novartis’ submission that the hyperlink provided by the complainant had been proactively shared by the named employee with his/ her connections on the LinkedIn platform. 

The Panel noted that the original article appeared to have been authored and posted by a journalist at LinkedIn as part of a weekly ‘Premium report’ which highlighted healthcare news.  The original post contained a video and written report of an interview with a named Novartis senior leader.  The Panel noted Novartis’ submission that the content of the article was focussed on the business approach to a product launch and lessons learnt from the launch of Entresto.  The Panel noted that Entresto was mentioned several times, predominantly in relation to the US health environment, its sales and cost-effectiveness data.  The Panel disagreed with Novartis’ submission that the article did not position Entresto positively. The article referred to the Institute for Clinical and Economic Review categorising Entresto as cost-effective and the American College of Cardiology and the American Heart Association issuing guidelines which referred to Entresto as the standard of care for certain heartfailure patients, a decision, that the article stated, was often seen as a gold standard in pharmaceutical commercialisation.  In the Panel’s view, an employee of Novartis proactively sharing the article with his/ her connections on LinkedIn was considered to be promotion of Entresto, a prescription only medicine, and the ‘share’ and its associated content should have been certified. A breach was ruled. 

The Panel considered that on the balance of probabilities not all the employee’s connections would have been health professionals and therefore sharing of the article with his/her network constituted promotion of a prescription only medicine to the public and a breach was ruled.  Furthermore, and on balance, the Panel considered that the positive statements in the article could on the balance of probabilities have encouraged members of the public to ask their health professional to prescribe Entresto and therefore a breach was ruled.

2            Advertising VivindaTV, a resource intended for health professionals, to the general public

The Panel noted that the hyperlink provided by the complainant led to a Novartis post on LinkedIn that referred to the latest research in dermatology and referred to Vivinda TV and sessions from a dermatology congress.  Readers were invited to register.  The linked registration page clearly stated that to create an account the individual had to declare that he/she was a health professional and their country of practice.   The Panel noted that neither the original post nor the linked registration page directly or indirectly referred to specific medicines. The Panel noted Novartis’ submission that it appeared the employee in question had ‘liked’ not ‘shared’ this Novartis post.  Regardless of whether it was liked or shared, the Panel considered that neither the post nor the linked registration page contained any product related information.  The viewer would have to register as a health professional to see further material. The Panel therefore did not consider that the employee’s endorsement constituted promotion of a prescription only medicine to the public; no information about medicines was supplied to the public and no breaches were ruled accordingly.

The Panel noted that the complainant alleged that materials shared had not undergone internal review. The complainant referred to ‘shared (liked posts)’ and thus the Panel considered that the allegation covered both ‘shared’ and ‘liked’ posts.  The Panel noted its comments above that the original post and the linked registration page made no direct or indirect reference to a specific medicine and therefore was not considered as promotional material that required certification.  Nor did the Panel consider that it was non-promotional material which required certification.  No breaches of the Code were ruled.

3            Advertising a Novartis press release about Cosentyx Phase 3 data

The Panel noted that the third hyperlink provided by the complainant led to a Novartis post announcing data in psoriasis at a 2018 dermatology annual meeting.  The post itself did not contain any reference to a product but according to Novartis the ‘find out more’ link led to a press release about Cosentyx data from the congress.  The complainant referred to a press release and Phase III data for Cosentyx.  The Panel noted that Novartis had not provided a copy of the press release.  The company submitted that the press release was initiated by the Swiss based headquarters and had not been examined by the UK company. 

The Panel noted Novartis’ submission that the post was ‘liked’ by the named employee and not ‘shared’. The Panel noted its comments above about the number of ways an individual could endorse a post which included ‘liking’.  The Panel noted Novartis’ submission that following receipt of the complaint it had identified information about how activity on LinkedIn was visible to one’s connections on their feed.  Although it appeared that Novartis had known that a ‘share’ would alert an individual’s connections to the activity, it had not realised that a ‘like’ could also alert one’s connections.  Novartis submitted that LinkedIn appeared to have an algorithm which decided which ‘likes’ it would alert one’s connections to.  The Panel was surprised that this issue had not come to light previously.  It was not inconceivable that similar issues might have occurred previously wherein a ‘liked’ post had been disseminated to a Novartis employee’s connection(s).  The Panel understood that if an individual ‘liked’ a post it increased the likelihood that the post would appear in his/her connections’ LinkedIn feeds, appearing as ‘[name] likes this’. In the Panel’s view, companies should remain vigilant and needed to ensure that they took reasonable steps to highlight the potential compliance issues that might arise from ‘liking’ certain posts if such posts could thereby potentially be pushed to their connections’ feed. 

The Panel noted Novatis’ explanation that the nature of such an algorithm meant that an individual could not anticipate the outcome of ‘liking’ a post therefore Novartis did not accept that ‘liking’ a LinkedIn post was proactively disseminating information in the same way that ‘sharing’ a post was.  Novartis acknowledged that if the named employee had ‘shared’ the post it might constitute promotion to the public.

The Panel noted that whilst the complainant had provided a copy of the original Novartis post, beneath which was a list of likes, he/she referred to ‘receiving information’ on LinkedIn.  The Panel therefore considered that on the balance of probabilities the employees ‘like’ had been disseminated by the algorithm to his/her contacts and further considered that such dissemination was the subject of complaint.

In the Panel’s view that an algorithm had disseminated an individual’s ‘like’ did not absolve Novartis from responsibility.  The Panel considered that the proactive dissemination of a press release about a prescription only medicine to those who were not health professionals or other relevant decision makers promoted that medicine to the public and might encourage such recipients to ask their doctor to prescribe it.  Breaches were ruled.  The Panel considered that the ‘like’ of the post and its associated content would constitute promotional material and would require certification under the Code.  A breach was ruled. 

The Panel was mindful of the complex issues that had to be addressed by companies when advising staff about personal social media use.  The increasing use of social media, both in personal and business capacity presented challenges.  In addition, many social media platforms used algorithms and had settings which individuals and companies might not be fully aware of.

The Panel was aware that the types of activity performed by the named employee on LinkedIn was not uncommon across the industry.  In the Panel’s view, employees might feel inclined to endorse articles related to their senior colleagues on LinkedIn or their company’s corporate social media posts and depending on the content such activity might or might not fall within the scope of the Code, therefore companies needed to issue specific and unambiguous guidance on personal use of social media.  This was particularly important if UK employees were likely to follow the social media accounts of overseas affiliates which might have codes, laws and regulations that differed to the UK.  In the Panel’s view it was very important that companies regularly reviewed such guidance.

In the Panel’s view, the global social media guidance issued by Novartis to its employees prior to the complaint and dated 2016 was open to interpretation.  The Panel was concerned that at the time of the LinkedIn activity in question there was no UK local guidance.  The Panel noted that after Novartis was notified of this complaint a UK wide communication was sent.  The Panel was concerned about the absence of UK specific guidance at the relevant time.  The Panel noted its comments and rulings of breaches of the Code as set out above.  Overall, the Panel considered that high standards had not been maintained and ruled accordingly.  On balance the Panel did not consider that the circumstances warranted a breach of Clause 2.