An anonymous, non-contactable complainant who described him/herself as a concerned UK health professional complained about the promotion of imatinib (Glivec, Gleevec) on LinkedIn by Novartis Pharmaceuticals UK Limited employees.
The complainant stated that the LinkedIn post came to his/her attention as part of his/her LinkedIn feed with an article posted by a surviving myeloid leukaemia patient. The complainant had no issue with the patient voice using social platforms, however, the US brand name Gleevec was used and was phonetically identical to the UK version, Glivec.
The complainant understood that normally this would be outside of the UK Code, however:
• An employee of another named pharmaceutical company re-shared the patient’s post advertising this to anyone connected via LinkedIn
• A Novartis employee then liked the shared post (imatinib was a Novartis product) which would have also posted to their connections feed a promotional message with brand name
• A second Novartis employee then both liked and commented on the patient’s post. In the comment the Novartis employee referred to imatinib by the UK Novartis brand name ‘Glivec’, again a promotional message
• Finally, across both companies it appeared individuals were happy to ‘like’ posts that could be perceived as promotional in intent, given the strapline ‘Once terminal, now controllable’.
The complainant was not aware of, and had not investigated, the disclosures between Novartis, the other named pharmaceutical company and the specific patient and clinician. However, given the nature of the article and the friendly comments, the complainant queried if it was a commissioned article.
By re-sharing that post, the complainant alleged that all three UK pharmaceutical employees had, de facto, created promotional material (further supported by colleagues) in which an unsubstantiated main claim on patient survival and no references were made – Gleevec and Glivec were phonetically identical and the same medicine, therefore, he/she considered them one and the same for UK Code purposes. The post and comments would have reached a substantial number of LinkedIn users that were not health professionals or patients, ie the public.
The complainant stated that this was of particular importance given the message delivered within the original patient post regarding long-term survival whilst treated with imatinib with the claim ‘Once terminal, Now controllable’, which sounded like a pharmaceutical industry product claim. The complainant did not believe the data supported that myeloid leukaemia was controllable for all patients on imatinib.
In addition, the Novartis employee’s specific comment on the LinkedIn post ‘Glivec is a lifesaver drug’ used the UK brand name and would amount to a strongly worded promotional claim without substantiation.
The complainant requested that the PMCPA considered the employee of the other named pharmaceutical company and the two Novartis employees’ actions on behalf of their respective companies. Both companies should be very aware of the public nature of LinkedIn (and therefore it was irrelevant that imatinib was not a product of the other named pharmaceutical company) and the use of brand names within the UK in relation of promotion to the public and, in particular, patients.
The case preparation manager only took this complaint up with Novartis as the marketing authorisation holder for Glivec and not the other named pharmaceutical company as although the individual had previously worked for Novartis, at the time he/she shared the LinkedIn post, he/she was working for the named pharmaceutical company which was not the marketing authorisation holder of Glivec.
The detailed response from Novartis is given below.
The Panel noted that the original LinkedIn post was made by a patient advocate who lived in the US and stated ‘I’m blessed! 26.5 years after terminal cancer diagnosis’ followed by the bold heading ‘Once Terminal, Now Controllable’, beneath which was a photograph of the patient advocate with a health professional followed by the text ‘[named patient advocate] (left) was diagnosed with chronic myeloid leukemia and was running out of time when he enrolled in a clinical trial studying Gleevec, a targeted therapy developed by [named health professional] (right)’.
The Panel noted that Employee 2’s (as referred to by Novartis) comment on the original LinkedIn post stated ‘Huge love to you [name] and the utmost respect to [named health professional] – Glivec is a lifesaver drug’ followed by a heart emoji. The Panel noted that whilst this employee no longer worked at Novartis, he/she was still employed by Novartis at the time that he/she ‘liked’ and commented on the original LinkedIn post. The Panel noted Novartis’ submission that as of 25 November 2021 when responding to the complaint, Employee 2 had around 200 connections on LinkedIn.
The Panel further noted from Novartis’s submission that the original LinkedIn post by the patient advocate above appeared to have been shared by an employee of another named pharmaceutical company who was an ex-employee of Novartis. In sharing the post, the employee of the other named pharmaceutical company stated ‘Still amazes me now… I remember the clinical trials starting in the U.K. with Imatinib, one of the first ‘targeted’ cancer treatments… The impact and beauty of science and innovation meet to trailblaze for the future!’.
The Panel noted Novartis’ submission that this shared post was also liked by a former Novartis employee (Employee 1 as referred to by Novartis) who had already left Novartis at the time he/she liked the shared post but had not updated his/her LinkedIn profile to reflect this. The Panel therefore did not consider that this individual’s actions, nor the actions of the other named pharmaceutical company employee who shared the original LinkedIn post, were within the scope of the Code as far as Novartis was concerned and it therefore made no rulings in this regard.
The Panel noted that the complainant included a screenshot of reactions to the post on LinkedIn, which included a ‘like’ from a further individual who was a current Novartis employee (Employee 3 as referred to by Novartis). The Panel noted Novartis’ submission that as of 25 November 2021 when responding to the complaint, Employee 3 had around 200 connections on LinkedIn. It was unclear to the Panel from the complainant’s submission whether Employee 3’s ‘like’ was in relation to the original LinkedIn post or the shared LinkedIn post. The Panel, however, noted Novartis’ submission that Employee 3 had liked the shared post which appeared on his/her feed, as a connection of the other named pharmaceutical company employee.
The Panel noted Novartis’ submission that the connections of Employee 2 and Employee 3, both employed by Novartis at the time they interacted with the original and shared LinkedIn post, appeared to be made up of both members of the public and health professionals.
The Panel noted the complainant’s concern that the data did not support the claim within the original post regarding long-term survival whilst treated with imatinib: ‘Once terminal, Now controllable’; the complainant did not believe the data supported that myeloid leukaemia was controllable for all patients on imatinib. The Panel noted that Novartis did not specifically respond in this regard except that the post was independently authored and shared by the patient advocate, with no input nor influence from Novartis UK. In the Panel’s view, the claim ‘Once terminal, Now controllable’ might misleadingly imply to readers that this was the case for all patients on imatinib which in the Panel’s view was incapable of substantiation as alleged. The Panel therefore ruled breaches of the Code.
The Panel considered that Employee 2’s comment on the original LinkedIn post by the patient advocate, that Glivec was a ‘lifesaver drug’, was in effect a strong promotional claim. The Panel considered that the claim was unequivocally an exaggerated claim that was unbalanced and incapable of substantiation and ruled breaches of the Code as acknowledged by Novartis.
The Panel noted that Employee 3 in ‘liking’ the shared post and Employee 2 in ‘liking’ and commenting on the original LinkedIn post had, on the balance of probabilities, disseminated the posts and comment to the employees’ individual networks, which included members of the public. Noting the content of the original LinkedIn post, Employee 2’s comment on it and the content of the shared post ‘liked’ by Employee 3, the Panel considered that a prescription only medicine had been promoted to the public. The Panel therefore ruled a breach of the Code in relation to each of Employee 2 and Employee 3’s activities as acknowledged by Novartis.
The Panel noted that the activities of Employee 2 and Employee 3 might encourage members of the public to ask their health professionals for imatinib. The Panel further noted Novartis’ submission that Employee 2’s comment that Glivec was a ‘lifesaver drug’ in the context of the title of the original post raised unfounded hopes of successful treatment. The Panel therefore ruled a breach of the Code in relation to Employee 2’s activity as acknowledged by Novartis and in relation to Employee 3’s activity.
The Panel noted its comments and rulings of breaches above and ruled that high standards had not been maintained in breach of the Code.
In relation to Employees 2 and 3, the Panel noted Novartis’ submission that there was no instruction from Novartis for the employees to like or comment on the LinkedIn posts. The Panel further noted Novartis submission that all three Employees were instructed by Novartis as soon as it received the complaint to ‘unlike’ the posts and to remove any comments, and it confirmed that this had happened.
The Panel did not consider that the LinkedIn posts failed to recognise the special nature of medicines or respect the professional standing or otherwise of the audience to which they were directed or were likely to cause offence. The Panel therefore ruled no breach of the Code.
The Panel noted Novartis’ submission that the original LinkedIn post was independently authored and posted by a patient advocate and shared by an employee from another named pharmaceutical company without any involvement from Novartis UK. The Panel further noted that it would have been clear that the posts had been disseminated on LinkedIn by the actions of Employee 2 and 3. The Panel, noting its comments above therefore ruled no breach of the Code.
The Panel did not consider that there was evidence that Novartis’ representatives did not receive adequate training and no breach was ruled.
The Panel noted Novartis’ submission that it was not involved in the preparation or creation of the posts. The Panel, however, considered that in disseminating the LinkedIn posts to their connections, Employee 2 and 3 had, in effect, created their own piece of promotional material. The Panel noted Novartis’ submission regarding its Social Media Policy and that the company had provided extensive online, face-to-face and live training as well as numerous internal communications on the appropriate personal use of social media. Additionally, there were several standard operating procedures (SOPs), policies and learning tools which Novartis submitted it had put in place to address the risks associated with the use of personal social media and that its training records confirmed a 98.18% completion rate of the social media training module amongst UK employees. In the Panel’s view, there was no evidence that the employees had not received relevant training as alleged and no breach of the Code was ruled.
The Panel ruled no breach of the Code as it did not consider that the complainant had raised a concern in relation to the requirement in the Code to provide accurate and relevant information about the medicines which the company markets to health professionals and other relevant decision makers upon reasonable request.
The Panel noted Novartis' submission that Employee 2 interacted with the Post entirely of his/her own volition and such conduct was not associated with any activity endorsed by Novartis. According to Novartis, Employee 2 was trained on the social media policy in autumn 2018 and Novartis had reinforced the rules and principles of this policy through extensive training which had been provided since 2018 to both existing and new joiners. The Panel further noted Novartis’ submission that it had also disseminated numerous communications on the appropriate personal use of social media but Employee 2 had failed to comply with Novartis’ policies and instructions. The Panel considered that it was particularly important that information made available to the public about such a sensitive issue as myeloid leukaemia was fair and balanced and did not raise unfounded hopes of successful treatment. Whilst the Panel was concerned with Employee 2’s reference to Glivec being a ‘lifesaver drug’, the Panel, on balance, did not consider that the particular circumstances of this case warranted a ruling of a breach of Clause 2 which was a sign of particular censure and was reserved for such use and no breach was ruled.