Companies tweet a lot. Twitter itself aspires to replace a large chunk of the market research industry. Sony tweets Play Station users. AstraZeneca tweets people in the US (mostly with links to corporate press releases, apparently—a real loss for those of us outside North America). Boehringer Ingelheim tweets clinical trial results, but no one yet really tweets patients.

Facebook is a bit more complicated for its users and probably impossible for most pharma companies.

The average user has about 130 "friends" who they have invited to get news about what they are doing, thinking, reading, watching, or worrying about. Any friend can send you material publicly or privately. And while Facebook has now made it possible to maintain several different profiles, it still throws up surprises nonetheless. For instance, I had to think: What would my clients at big liberal foundations make of the friends from my days as a fraternity rush chairman in Alabama—the friends who have an annoying habit of identifying me in incriminating pictures from the 1970s?

Still, some heavyweight world figures are ready to risk MAH. HM Queen Rania of Jordan has over 12,000 supporters on Facebook—for every snide remark, there are a hundred like this, "u r the best of the best in the world.... i love u my Queen."

Then again, what about pharma companies? Are they ready for an age of MAH?

Pharma friendless on Facebook

Most Facebook content is generated by users or modified by them. The researchers I know on Facebook often make unguarded comments about the data they have seen or the pet theories they are developing. When a senior pharma industry executive who works in New Jersey sent a status update that he was in Ethiopia for a project, I made a point of finding out why.

Some institutions do well on Facebook: I am one of 308 members of the Council on Foreign Relations group and one of about 1,000 of a media group run by the British paper The Guardian. But neither the CFR nor The Guardian is patrolled by corporate lawyers and both groups thrive on lively discussions.

Johnson & Johnson subtly gets around this by using My Space for a nice safe contest focused on its body care brands, but does not talk about oral contraceptives.

But for now, at least, you don't have the option of being too straight-laced and corporate.

Patients have lots of friends

With or without pharma, health groups are growing fast on Facebook. Danielle from Dallas told the global Asthma Awareness group on the day I am writing this, "Xolair rocks. I took it for two years, while my ins covered it, and I was sick maybe 2 or 3 times a year while on it. I have been off for 3 years due to the expense and I get sick once every couple of months while I am off it." Dani from Hawaii added her Xolair experience, "my doctor automatically prescribed an epi pen for me and went over its use, mainly for the first 24 hours after your first few injections. I had absolutely no problems. I was very worried like yourself. I am on several medications for asthma too. I take a lot of prednisone. I take Advair 500/50 twice a day."

Imagine if an asthma company had had any link to the conversation. The lawyers would be calling for the intravenous diazepam, not the epi pen.

An ad agency executive speaking to an industry blogger recently noted mournfully, "corporates don't get many friends on Facebook."