TOP 50 HEALTHCARE PR: PR remedies - While healthcare PR has been in the headlines recently, Adam Hill finds a customer-focused approach plus greater client/agency affinity is changing pharma companies agendas

In 2000, the trend first highlighted in the 1999 PRWeek healthcare

league table, namely the move towards more customer-focused work,

continued.



And while the gripe, that newly-appointed in-house brand managers don't

always understand what healthcare PR has to offer, remains in some

circles, there is a feeling that there is generally more affinity

between client and agency than ever before.



Product communications has also come to the fore as a result of the

National Institute for Clinical Excellence's (NICE) insistence that

manufacturers prove their products are as effective as others in the

marketplace. Grayling Healthcare chief executive Peter Holden says: 'If

NICE says GPs should or shouldn't use a certain drug, that's something

no amount of PR will affect.'



There is an increasing focus on branding issues long recognised by

clients outside the healthcare sector. 'Clients are starting to look at

'what is a healthcare brand?',' says Hill & Knowlton director of health

and pharmaceutical Mike Kan. 'For clinicians, companies have to offer

more than the sum of the parts of their product.'



The question of branding for the consumer reaches well beyond the narrow

confines of the product. Issues surrounding animal rights and corporate

social responsibility came to the fore with the recent furores over

manufacturers' stance on HIV drugs in South Africa, and demonstrations

at Huntingdon Life Sciences which have highlighted the public scrutiny

of the sector.



In some cases this has led to a restructure. GCI Healthcare took the

opportunity, following its acquisition of OTC specialist Maureen Cropper

Communications, to split its operation into two: ethical pharmaceutical

and OTC. The latter has three directors working on medicines,

complementary medicines and personal care products.



Pharmaceutical work and medical education continue to account for the

lion's share of many agencies' fees . There has been some debate about

the roles of medical education and PR in the healthcare arena, and

whether the division between the two is blurring. Since both are

concerned with communicating messages to audiences it is easy to see

where the overlap lies. The main difference between the two, PROs say,

lies in the fact that while medical education is driven by the

scientific data behind a product, PR is more about the issues

surrounding it.



Where budgets allow for the appointment of a medical education company

in the earliest stages of a product's lifecycle, the whole marketing

programme, including PR can be driven by medical education specialists.

When it comes to editorial, medical education specialists are more

likely to be involved in the writing of scientific papers from the peer

group perspective, as opposed to the more press release driven aspect of

PR.



Medical education is turning increasingly to new media because of the

ease with which it can be used to manage international data, contacts

and programmes. The tool developed by academics and scientists is now

being used to reach them. Shire Hall business development director

Gloria Gibbons cites the development of virtual communities of opinion

leaders on the net, or the creation of intranets within healthcare

companies, while Medical Action Communications managing director Smita

Desai points out that the internet allows symposia to be access

worldwide through the use of webcasts.



Client interest in DTC activity is also increasing. 'Across the board we

are seeing more interest in DTC programming and its various components

such as internet, traditional media relations and non-traditional

marketing,' says David Gallagher, Ketchum board director

(healthcare).



At present, pounds 830,500 of Cohn & Wolfe Healthcare's pounds 2.6m fee

income is from DTC but this is planned to grow. 'DTC is going to

increase as pharma companies are looking to address patients as an

increasingly powerful audience,' said executive director of healthcare

Angie Wiles. And as DTC advertising restrictions are relaxed, the need

for supporting PR will grow, she believes.



The agency set up a policy relations team last year to address licensing

and other policy issues. 'Policy-makers are an important audience,'

Wiles says. 'But that activity has got to be integrated with everything

else that's going on.'



As the NHS pushes pharmacists further up the diagnostic chain, they will

enhance their status on the front line. And nurses - particularly those

in specialist areas such as diabetes - continue to be an important

audience.



Grayling, which earned pounds 350,000 of its pounds 2m fee income last

year from DTC, has been mounting a campaign for Van den Bergh's Flora

Pro.activemargarine at nursing, cardiovascular and primary care

conferences to extol its virtues for patients with marginal

hypercholesterolaemia.



GCI has found that clinical trial recruitment work, which has been part

of its US practice for ten years, is increasingly important in the

UK.



'It is extremely popular with clients,' says Rachel Terry, MD of ethical

pharmaceutical. 'We are establishing a biotech practice (in the UK) as

well.' This will link with GCI's investor relations practice, 'working

with them to combine the dual needs of biotech companies: the City side

and healthcare PR expertise'.



A growing international perspective developed in 2000. 'There is an

increased belief in global PR from healthcare companies and more

opportunity for PR to provide global support in branding,' explains

Talman. Global, effectively, means America. While it may not provide a

blueprint for local markets - divided by different languages, different

attitudes to healthcare provision and different levels of government

involvement - UK agencies are looking west.



'You can look at the US in two ways,' says Avenue HKM chief executive

Joanna Marchant. 'On the one hand it is 39 per cent of the worldwide

pharma market; yet it is also a very specialised market. A lot of

decisions are moving to the US as well - you can see that with

GlaxoSmithKline, for example. That doesn't mean to say that continental

Europe isn't important too. But if you want to be an international

healthcare communications company you have to deal with the US.'



With North America's relatively lax regulation and market-led pricing,

and with European clients taking their lead from the US, it may seem a

short hop and a skip to a relaxation in the regulations here that say

that drugs cannot be directly marketed to consumers. Despite the

considerable opposition to tampering with the advertising directive,

Shire Hall group chief executive Margot James believes change will

come.



'Ultimately, it will happen,' she says. 'But there are a lot of hoops to

go through yet.' Modification of how the internet could be used to

market drugs is a more probable first step, although Lowe Fusion MD

Julia Cook says it has happened by the back door already online. 'I feel

strongly that patients can get information which is harmful because it

is not in context,' she explains.



Any changes in DTC advertising directives would require European Union

agreement, a process likely to take at least three years. Still, there

is a hint of change in the air. This month's Office of Fair Trading

victory in the High Court, effectively slashing prices of OTC products

in this country, may be a prelude to consumers being treated as adults

capable of making decisions about pharmaceutical products. Three decades

of resale price maintenance designed to protect chemists has been wiped

out at a stroke. 'It is a victory for consumers and supermarkets over

vested interests,' said one healthcare PRO.



But it is not just small pharmacists who are right to feel threatened:

for manufacturers who have perhaps lost up to half of their revenue

overnight, the move must throw up awkward questions about the size of

future promotional budgets.



Sante Communications MD Liz Shanahan says: 'It is a mixture of

opportunity and threat depending on the business you are involved in.

And it may be an issue for clients in other areas that could have an

impact on budgets. If I were working on Nurofen I'm not sure how I'd

feel today.'



It will be interesting to see whether agencies remain buoyant about OTC

business this time next year.



TOP HEALTHCARE CONSULTANCIES 1-30

Rank Agency Healthcare fee Total PR

income (pounds) % fee income

00 99 00 99 grth 00

1 1 Medical Action 10,200,000 9,900,000 3 10,200,000

Communications

2 2 The Shire Hall Group*1 7,019,000 5,903,000 19 7,019,000

3 3 Meditech Media 4,700,000 3,883,000 21 4,700,000

4 4 Hill & Knowlton(UK)* 4,079,800 3,370,380 21 28,934,000

5 - Avenue HKM2 3,599,000 - - 3,599,000

6 - Burson-Marsteller*3 3,545,536 - - 17,187,000

7 9 GCI/APCO* 2,951,000 1,778,098 66 16,828,000

8 10 Ketchum* 2,748,242 1,761,296 56 10,570,163

9 11 Cohn & Wolfe* 2,606,757 1,703,498 53 8,408,892

10 6 CPR W'wide/ 2,377,620 2,056,235 16 6,426,000

Fleishman-Hillard*

11 12 BSMG Worldwide* 2,150,306 1,669,598 29 17,919,214

12 7 Grayling Group* 2,043,932 1,829,173 12 9,290,600

13 13 Munro & Forster 1,874,264 1,610,122 16 2,677,520

Communications*

14 15 Edelman Public 1,777,784 1,440,113 23 10,457,554

Relations W'wide*

15 - Athena Medical 1,760,000 1,200,000 47 1,760,000

16 14 Countrywide 1,672,450 1,566,741 7 20,905,626

Porter Novelli*

17 17 Ruder Finn UK 1,566,691 1,288,500 22 2,410,294

18 16 Lowe Fusion Healthcare 1,328,365 1,320,537 1 1,328,365

19 - Chandler Chicco Agency 1,228,789 488,161 152 1,228,789

20 21 Sante Communications 1,038,510 781,920 33 1,038,510

21 23 Ogilvy Public 990,330 585,600 69 6,002,000

Relations Worldwide*

22 - Galliard Healthcare 980,000 - - 980,000

Comms4

23 5 Weber Shandwick*5 868,000 2,083,920 -58 31,929,000

24 30 Jo Spink Public 731,864 339,604 127 769,573

Relations

25 - Atlas Public Relations 684,324 - - 684,324

26 31 Myriad Public 673,992 333,950 102 1,123,320

Relations

27 26 Manning Selvage & Lee* 633,360 518,040 22 4,872,000

28 22 The Euro PR Group* 499,289 594,862 -16 1,664,295

29 - Chime Online 490,000 - - 10,741,000

30 29 Nexus Choat 468,160 372,600 26 4,256,000

Public Relations*

Rank Agency Staff % fee Location

income

00 99 00

1 1 Medical Action 72 100 Surrey

Communications

2 2 The Shire Hall Group*1 86 100 London

3 3 Meditech Media 121 100 London

4 4 Hill & Knowlton(UK)* 368 14.1 London

5 - Avenue HKM2 60 100 London

6 - Burson-Marsteller*3 194 21 London

7 9 GCI/APCO* 231 18 London

8 10 Ketchum* 151 26 London

9 11 Cohn & Wolfe* 98 31 London

10 6 CPR W'wide/ 76 37 London

Fleishman-Hillard*

11 12 BSMG Worldwide* 223 12 London

12 7 Grayling Group* 115 22 London

13 13 Munro & Forster 50 70 London

Communications*

14 15 Edelman Public 124 17 London

Relations W'wide*

15 - Athena Medical 20 100 London

16 14 Countrywide 264 8 Ox'shire

Porter Novelli*

17 17 Ruder Finn UK 34 65 London

18 16 Lowe Fusion Healthcare 22 100 Surrey

19 - Chandler Chicco Agency 15 100 London

20 21 Sante Communications 14 100 London

21 23 Ogilvy Public 76 16.5 London

Relations Worldwide*

22 - Galliard Healthcare 13 100 London

Comms4

23 5 Weber Shandwick*5 419 3 London

24 30 Jo Spink Public 11 95.1 London

Relations

25 - Atlas Public Relations 15 100 Leeds

26 31 Myriad Public 21 60 Cambs

Relations

27 26 Manning Selvage & Lee* 71 13 London

28 22 The Euro PR Group* 23 30 London

29 - Chime Online 166 4.5 London

30 29 Nexus Choat 75 11 London

Public Relations*

All figures relate to the year end 31 December 2000. Fee income=PR fees

+ mark-up.*Denotes PRCA member 1 Includes figures from 4D Communications

2 Set up under this name 1/1/2000 3 Does not include figures for 1999 as

revenue analysis by practice was only performed on a pan-European basis

4 Figures for ten months - only set up 1/3/00 5 Formerly Shandwick

International

TOP HEALTHCARE CONSULTANCIES 31-50

Rank Agency Healthcare fee Total PR

income (pounds) % fee income

00 99 00 99 grth 00

31 Pegasus Public Relations 455,909 - - 512,257

32 - HCC De Facto Group 430,276 - 1,955,800

33 25 Jonathan Street PR 384,368 525,542 -27 768,736

34 Jago Pearce 365,996 - 365,996

35 36 The Red Consultancy* 282,027 240,946 17 5,640,535

36 37 CCD Healthcare PR 260,000 236,000 - 260,000

37 - Fishburn Hedges 244,743 - - 8,158,111

38 - Clear Communication 236,062 - - 638,005

Specialists

39 27 BMA Communications 214,345 414,692 -48 1,907,745

40 43 Charlton Communications 210,000 82,373 155 1,047,034

41 38 Willoughby Public 204,240 217,871 -6 851,000

Relations*

42 48 Hobsbawm Macauley Comms 179,752 34,767 417 1,198,345

43 34 Barkers Public Relations* 170,836 265,106 -36 1,423,632

44 - Grant Butler 108,074 - - 3,602,455

Coomber Group*

45 - Media Strategy 91,200 - - 456,000

46 - College Hill 85,131 - - 9,830,934

47 - Brahm Public Relations 70,938 - - 2,364,587

48 - Harrison Cowley* 63,111 - - 6,311,128

49 - MXC Communications 48,235 - - 253,866

50 - Leader Communications* 28,700 - - 574,000

Rank Agency Staff % fee Location

income

00 99 00

31 Pegasus Public Relations 11 89 W Sussex

32 - HCC De Facto Group 46 22 London

33 25 Jonathan Street PR 11 50 London

34 Jago Pearce 9 100 Bucks

35 36 The Red Consultancy* 87 5 London

36 37 CCD Healthcare PR 6 100 London

37 - Fishburn Hedges 76 3 London

38 - Clear Communication 8 37 London

Specialists

39 27 BMA Communications 18 11 London

40 43 Charlton Communications 27 20 Oxon

41 38 Willoughby Public 28 24 B'ham

Relations*

42 48 Hobsbawm Macauley Comms 23 15 London

43 34 Barkers Public Relations* 27 12 B'ham/Glas

44 - Grant Butler 57 3 London

Coomber Group*

45 - Media Strategy 7 20 London

46 - College Hill 104 1 London

47 - Brahm Public Relations 21 3 Leeds

48 - Harrison Cowley* 114 1 Various

49 - MXC Communications 5 19 Essex

50 - Leader Communications* 15 5 Warwicks

All figures relate to the year end 31 December 2000. Fee income=PR fees

+ mark-up. *Denotes PRCA member



2001 HEALTHCARE LEAGUE TABLE CRITERIA



Entrants into the PRWeek Healthcare league table were asked to supply

the following information: what percentage of their fee income was for

healthcare PR, and the pounds sterling fee income in five sectors: OTC,

pharmaceutical, vitamins, medical education and DTC.



Companies like PPS who handle medical education lobbying are not

included in the league table as the work is not defined by the agency as

healthcare PR.



By far the biggest category by fee income is pharmaceutical,

particularly among healthcare specialists. Athena Medical's work is all

in this category.



But medical education also contributes a significant amount to some

specialist companies overall profitability: more than 50 per cent of

Avenue HKM's fees are for medical education, while Medical Action

Communications generates a third of its fees from the sector.



The big generalist firms also generate the majority of their healthcare

income from pharmaceutical work, but apart from that there is a mixed

picture looking at the secondary streams.



For Ketchum vitamins (pounds 273,000) is secondary while for Hill &

Knowlton OTC and medical education are on a par after pharmaceutical at

nearly pounds 1.1m each.



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