Healthcare companies have to work harder than most to win the public's trust.
There seems to be almost universal agreement - both anecdotally and in surveys - that trust in healthcare has been on the decline for some time.
PR and industry experts offer many explanations why, but agree on the point that healthcare companies need to be more visible to the public.
"Pharmaceutical companies are better at doing the right thing than communicating what they are doing," says Mike Tuffin, VP at APCO Worldwide and former director of strategic communications at two trade groups, America's Health Insurance Plans and the Pharmaceutical Research and Manufacturers of America.
"I don't think the industry has done a good job of communicating about the good works it's done."
A Harris Interactive survey from last year found that only 44% of respondents believed that drug companies were doing a good job of serving their industries. Health insurance companies received favorable remarks from 36% of respondents, and managed-care companies from just 30%, the same percentage as tobacco companies.
But David Shore, director of the Trust Initiative at the Harvard School of Public Health and author of The Trust Prescription for Healthcare, notes that healthcare companies are held to different standards than other industries.
"There is an inverse relationship between trust and perceived profitability [that is] unique to healthcare," he says, adding that the public believes that decisions in the healthcare industry should be "driven entirely by mission."
Because drug companies are perceived as being in the most profitable sector of the healthcare industry, they take a disproportionate share of the blame for problems within it.
"There's a lot of political rhetoric directed at the pharma industry, and it's had an impact," Tuffin says. "I think there is trust, [but] I think there's a lot of frustration with cost and access. People feel they have a right to have prescription drugs, and that's a powerful word."
Jeffrey Aronin, president of Ovation Pharmaceuticals, agrees that the industry is an easy target for politicians. And he believes that the situation has been made worse because of recent news events, such as the Vioxx recall and the black-box warnings on antidepressants.
"The situation is bad because public opinion is bad," he says. "Trust is lower than it has been because people are beginning to look at disclosure."
The healthcare delivery system is fragmented, and, to the public, no one seems to be accountable when things go wrong, notes Ben Singer, SVP and national practice leader for health services at FischerHealth. "There are a lot of pieces to the healthcare-trust puzzle," he says.
Drug companies develop compounds, but the Food and Drug Administration monitors them. Doctors prescribe treatments, but health insurers decide whether to pay for them.
"In healthcare, uniquely, one doesn't have quite the same capacity to assess the product," Shore says. "In healthcare, we use proxies, substitutes ... and particularly the issue of reputation."
Edelman uses a proprietary tool developed by its research arm, StrategyOne, to assess the impact of trust. Jennifer Scott, president and GM of StrategyOne, explains that trust actually has three components: integrity, dependability, and competence.
She notes that pharma clients tend to score high on competence, but fall down on the other two markers. "[Individuals] don't always believe [drug companies are] being fair and just or that they're going to follow through," she says.
Scott adds that trust allows businesses to operate more efficiently and mitigates the threat of lawsuits. "When trust drops, the demand for verification goes up," she says.
Put another way, Shore notes, after the recall of Vioxx, Merck's stock price dropped 40%, even though the drug represented just 10% of the company's annual revenue. "You can argue that that variance was the trust equity," he says. "Trust serves as a firewall in case of adversity."
Importance of consistency
There are a number of ways to build trust, but Shore says that the one most relevant to PR practitioners is being able to deliver a consistent message.
Retail franchises "obsess about this idea of consistency," he says. "If you want to be a power brand, you don't want to be perceived as ephemeral."
Wendy Lund, director of the New York healthcare practice at MS&L, says integration across marketing channels is one way to reinforce that message. "A lot more questions are being raised," she says. "Patients have gotten so savvy; we have to get more sophisticated about how we educate them."
Currently, there are very few companies that can claim trust as part of their corporate brand, Shore notes. But many have started to try.
"Building trust requires having a trustworthy reality and then communicating it really well," says Nancy Turett, president and global director of Edelman's health practice.
She notes that healthcare companies do have programs in place that increase access to drugs - but the public is still unfamiliar with them. "People closer to the pharma industry trust them more," she says. "There's a reason for that."
Several drug companies, such as GlaxoSmithKline (GSK) and the newly merged Sanofi-Aventis, have established positions for chief reputation officers at their global headquarters.
GSK has also undertaken a grassroots campaign in the US, encouraging the same sales reps who promote drugs to doctors to talk about drug costs in front of their community groups.
And Bayer late last year launched its "Science for a better life" campaign to improve the image of the company and to unite its three business divisions under a single corporate brand.
At Eli Lilly, president and CEO Sidney Taurel has talked candidly about the image of drug companies, as well as the problems facing the healthcare system overall.
"The dialogue around the negatives of the industry has increased ... so our actions and dialogue have increased," says Edward Sagebiel, corporate communications manager at Lilly.
Although Sagebiel would not reveal what PR tactics the company is using to build trust, he notes that Lilly has been promoting its drug discount card and disclosing results from clinical trials.
"We've leveraged those messages in the media quite well," he says.
Trust in other areas
Singer, who joined FischerHealth from PacifiCare Health Systems, where he led strategic communications, notes that managed-care companies are similarly trying to position themselves as "consumer healthcare organizations."
"The insurance industry is really trying to put its foot on the accelerator and position its name and its brand as something that stands for trust," he says.
But he acknowledges that it's too soon to tell if those campaigns are resonating with consumers. Health maintenance organizations, for instance, must talk more about how they increase efficiency and reduce costs - and get away from the stigma that they take choice away from patients, he notes.
"Too many companies shy away from the limelight," he says. "When you think about trust and reputation, it's not discretionary."
Shore notes that surveys also show that individuals tend to trust their own personal healthcare providers, believing they have the "one good one" in the industry.
The issue of trust also plays out differently across the many sectors of the healthcare industry.
The public makes a distinction between corporations and nonprofit groups, for instance, and partnerships between the two have become more sophisticated in healthcare.
Lund, who joined MS&L from the Planned Parenthood Federation of America, notes that advocacy groups are better able to connect with patients regarding disease information.
And she notes that the recent public mistrust of drug companies hasn't tarnished those relationships. "I haven't seen any decrease at all in the ability and the [desire of advocacy groups] to work with pharma companies," she says, adding that the relationships are "instrumental and critically important."
At Ovation, Aronin notes, working with third-party partners is a key element of getting messages directly to patients. "As people begin to look deeper at the values of the pharma industry," he says, "they'll understand that the solutions and the problems are not as simple as they seem."
The industry fights back
With new leadership in place this year, the Pharmaceutical Research and Manufacturers Association (PhRMA) has set the image of the drug industry as a top priority.
Billy Tauzin, PhRMA president and CEO, has spoken candidly about the industry's reputation, telling reporters that drug companies must "re-earn the trust and confidence of the American public."
It's still too soon to say what PR measures the influential trade group will put in place, but such measures will likely serve as a model for its member companies. PhRMA has a new SVP of communications, Ken Johnson, and is currently reviewing its relationships with agencies.
But Jeff Trewhitt, a PhRMA spokesman, explains that an ongoing initiative is to publicize ways that the industry is helping increase access to drugs.
"It's certainly our intent to win back the trust of the people who take our medicines," he says.
PhRMA currently set up two websites - helpingpatients.org and innovation.org - to communicate about patient assistance programs and drug R&D, respectively.
"It's important for patients to understand that these medicines ... help to save lives and improve the quality of life," Trewhitt says.