American business Bible Forbes doesn't think you have, at least not if you're a European CEO. Then again, the Forbes' article that says European CEOs don't Tweet was written six weeks ago, and a lot can change in six weeks Twitter time.

Over the past six months, growth in usage of the micro-blogging phenomenon has been, well, phenomenal. According to Techcrunch, new user stats for the three-year old web business look something like this:

• 70% of Twitter users joined in 2008
• 20% of Twitter users have joined in the past 60 days
• An estimated 5,000 to 10,000 new accounts are registered each day

Looking at these numbers, and reading the popular press, I’m willing to bet that everyone reading this article has at least heard of Twitter, if they are not actually using it. However, knowing that Twitter is out there and using it effectively in the context of pharma business are two very different things.

Some would say that business just shouldn’t be using Twitter at all. Stan Schroeder, features editor at social media guide Mashable.com, says in a recent blog post that delivering corporate information in Twitter's 140-character chunks is more or less useless.

"If the CEO really wants to tweet, great; but if it's a fake, corporate thing where he/she simply has an assistant writing the tweets, it's pointless, because people will get it, eventually."

This is not the American experience, at least not as reported by Forbes. The magazine quotes Shel Israel, author of the forthcoming book Twitterville, as saying: "If the EU business community wants to have efficient conversations with customers and partners like US companies have, they will get to Twitter, sooner, faster and in greater numbers."

Don't say we didn't warn you.

Assuming Forbes, Mr Israel, and companies like Starbucks are right, what should European Pharma be doing with Twitter?

The first thing, says Andrew Spong, STM publisher and the brains behind the STweM blog, is ask itself some serious questions.

"Why are they interested in using social media at all?" he asks. "What do they hope to achieve, and on what basis will they measure their success? What timelines are they working to?"

Improving communication with patients and doctors is probably the most often cited reason for pharma using any form of social media. This is certainly one area where Silja Chouquet, founder of Basel-based social media coach Whydot GmbH, sees some opportunity.

"In the case of patients and physicians, pharma can have a three way communication or simply facilitate the physician/patient relationship by providing infrastructure and content."

This isn't happening at the moment, however. Chouquet sees five or six Big Pharma companies that have entered the Twitter arena in the last six months or so using it very generally. "Usage is limited to communicating with journalists or the general public, pushing out press releases," she says.

For the social media experts this is absolutely the wrong way to go.

Echoing Schroeder at Mashable, Matt Rhodes says it is important for pharma to actually engage on Twitter. Rhodes, head of Client Services at London-based social media agency, FreshNetworks, explains, "If you want to build your credibility and Followers, then spend some time searching for people with problems you might be able to help with. Follow them and then send them a message with some thoughts. This kind of interaction will boost your credibility hugely and will mean you're actually taking part in Twitter. Only when you build this conversational and long-term relationship will you build real trust."

Marketing director Andrew Beaven from market analysts EvaluatePharma agrees in principle, but sees some difficulties. "The problem is the apparent insubstantiality of the medium. Short comments can only really point to other resources, so I think it can be harder to develop a profile as a trusted commentator."

Both Chouquet and Rhodes say that the secret here is not just about using Twitter, but integration with other social media tools and meaningful content.

Whydot, with clients like Novartis in its portfolio, is currently looking at potential uses of Twitter around scientific conferences to update those that are not there. "We will have a sort of social media reporting in place using blogs, video interviews, podcasts and Twitter," says Chouquet.

Whether Tweeting one-to-one or to conference absentees, everyone agrees that it's good to talk and that Twitter makes it easy.

Unfortunately, this still leaves the 800-pound social media Gorilla sitting square in the centre of pharma's living room. Engaging in social media of any form means corporate pharma types will have to get their head around the idea that they are in a conversation and that people will talk back.

"I see pharma getting into Twitter in a big way for reputation monitoring; it looks to be the perfect place for people to sound off about the evils of Big Pharma," says Beaven.

It goes further than this for Andrew Spong: pharma has to get comfortable with the idea of relinquishing control of their brands. "Do they understand the underlying Web 2.0 idea that the customer, not the company, owns the brand?" he asks. "Are they comfortable with affording their customers access to tools that will potentially reorient, perhaps completely invert, their key messages?"

A couple of times during the research for this article, Twitter told me it was over capacity. When this happens you get the polite message, "Too many tweets! Please wait a moment and try again," accompanies by a sweet image of eight tiny birds desperately trying to lift a massive whale.

The birds and the whale may prove to be an appropriate analogy for pharma and its nascent use of Twitter? Such an open communication platform will struggle to bear the weight of such a heavily regulated industry, carry the responsibility that pharma has for doctors and patients, and still facilitate meaningful multi-directional communication.

Chouquet says the best way for pharma to find out what's possible is to start using Twitter internally to get a feel for how it works and what it can do.

"Companies should craft clear guidelines for employees on the do's and don'ts of social media usage professionally and privately." She also suggests trying to follow regulatory guidelines where possible, but acknowledges that every regulator in the world is currently playing catch up.

You might be wondering if it's all worth the effort. Listen to Andrew Beaven at EvaluatePharma.

"My perception until very recently was that Twitter was another Second Life, a potentially interesting technology platform waiting for the killer app. But it could well be that Twitter is the killer app."

According to Forbes, you heard it here first.