When it comes to finding patients, the clinical site universe is starkly partitioned. Perhaps one clinical site in twenty is superb, reaching difficult patient recruitment goals. Such sites make industry-sponsored research happen. Without them, the life sciences would grind to a halt.

The remaining 95 percent of sites are not set up for science that scales. Those sites struggle from the start, stumble through regulatory minefields—and typically find zero patients or a single patient. Those sites sap the attention, patience and resources of the sponsor community. Such has been the case for decades.

That sobering two-tier scenario is continuing with the well-established usage of the internet for patient recruitment. This week's 2011 Drug Information Association annual meeting had a fascinating session on the digital divide between clinical sites that are a) electronic recruitment experts or b) developmentally delayed.

Digital Divide

On one half of the chasm sit a small fraction of sites that use social networking and online advertising with more ease and sophistication than the largest names in the sponsor community. On the other side, semi-bewildered sites log onto Facebook and do little more than research the whereabouts of long-lost high school paramours.

Elizabeth Moench, president and CEO of MediciGlobal, moderated the DIA panel. She relayed some results from a survey of site personnel. “Eighty percent of sites have confusion between emarketing and social media,” she said.

Translation: some investigative sites don’t understand the difference between updating a personal Facebook page and buying an ad on Facebook to tell people about a trial and, say, target African-American women under 30 years old. Twitter, Craigslist, and centralized online marketing firms for clinical trials all have their own terminology and nuances, almost like the cultures of small Eastern European countries. Many sites are appropriately so wrapped up in patient care that they may never learn to navigate web advertising for patients.

Trusted Sources

But a few sites are diving into this new world with gusto. As we'll describe in a future story on the same DIA session, these sites are finding patients faster and more inexpensively than with radio or newspaper ads. Moench related that such investigative sites understand the long-term, dedicated approach that the new media require.

In a context of communicating with patients, she said, electronically savvy sites sites know they must cultivate their own reputations, their own relationships with content-driven websites in a particular therapeutic area. Said Moench: “The source of the information is very important to patients. The transparency is absolutely critical. Forming all these links takes time. It is not just one posting and that is your campaign.”

Yet even for clinical sites that are using online patient recruitment techniques, she said, some are largely going through the motions. They’re using the online channel, but just to demonstrate their general enthusiasm to a sponsor. The next level of marketing sophistication—using data from one campaign to quickly reallocate financial resources to another—is much more rare.

Said Moench: “Gathering usable metrics in which to make decisions—there is a gap here. That has still not happened.”

Stagnant Budgets

Moench sounded an alarm on the next twelve to eighteen months. She said that the lagging sites, technologically challenged sites, will be falling so far behind in their recruitment goals that the overall productivity of many sites will be at stake.

And with some ruefulness, Moench noted her own previously published observations about many sites receiving a canonical, industry standard $5,000 sum to advertise a trial in a limited local area. But in the years since, those costs in the real world have changed considerably. “Seven years later, [the amount] has not kept up with inflation. It has not kept up with traditional media,” she says. ”We're going to have more recruitment projects failing if there is not a mix of emarketing in the campaign.”

Going Mobile

She is worried about trials and sponsor-site relationships being negatively affected by chronic recruitment delays. The causes may be complex: insufficient spending, lack of sophistication or inappropriate reliance on old-school advertising methods. “We've got a major ramification occurring as we see less return on investment,” she warns.

In some cases, she said, proactive sites selectively spend their own funds to advertise for patients online. The objective is to perform on a single trial or build a foundation for future projects with the same sponsor. That's clearly a sign of sites run as modern businesses.

The most forward-looking sites, Moench says, are already hunting for patients on mobile devices. (Mobile devices, for the uneducated, include Blackberries and iPhones and Android phones.) Some clinical trial sites are customizing ads for such exotic, otherworldly objects, which (if memory serves) were a major plot element for one of the Star Trek movies. d9A2t49mkex

Some sites are even using web-based systems to receive initial contact from prospective patients via text or SMS messages. Once again, sadly, a divide between the e-recruitment sophisticates and the online Luddites remains. Notes Moench: “The early adopters and majority are now shifting. But we still have over 80 percent that are the late majority and the laggards.”