Pharmaceutical companies and their PR partners are working hard to increase positive perceptions of the industry in France, one of the most populous countries in Europe, following a scandal that shattered trust in the industry.
The drug that caused the tension, Mediator, was supposed to help manage diabetes, but for many, it was a ray of hope in their battle to lose weight.
Manufacturer Laboratoires Servier allegedly encouraged this non-prescribed use through off-labeling promotion to doctors. Something the company didn't share were the cardiovascular risks associated with the drug.
By the time French authorities ordered the drug off the market in 2009, there were 300,000 active prescriptions. To date, some health officials estimate that as many as 2,000 people died, with many more hospitalized due to cardiac valve damage and pulmonary hypertension likely related to the drug.
"The general public is not interested in what pharmaceutical companies have to say. People feel they are focused on the fact that they make money out of other people's illness," explains Juliette Billaroch, head of healthcare for Presse-Papiers, a Ketchum affiliate in Paris. "Healthcare professionals don't want to be linked to pharmaceutical companies as they fear the reputational consequences."
In late 2011, the law, Reform du Medicament, went into effect. Its intent is to strengthen the regulatory framework for the promotion of pharmaceutical products in France.
The law's provisions are plentiful, with cascading rollouts, the most potent related to medical product companies reporting payments they make to various stakeholders. However, there were also several provisions that impacted communication practices by the companies.
In France, regulatory standards around communications were already strict, with direct-to-consumer promotion for prescribed drugs forbidden for years.
How one-on-one education is conducted at hospitals is being impacted by the Reform du Medicament.
A forthcoming requirement is that visits from pharmaceutical representatives to hospitals be limited and take place as collective visits of at least three people at a time.
"This way [healthcare providers] can say that the relationships are completely transparent," says Lestra Laurence, director of public affairs and communications at Boehringer Ingelheim in France.
Even though that part of the law has yet to be implemented, "hospitals are already reducing the amount of visits representatives can make," adds Laurence.
Now before companies can release product communications targeting health professionals, prescribers, or consumers in the instance of over-the-counter products, they need to get special visas approved by French health product regulators. The additional rub is there are only a few periods each year when companies can submit their request for the visas.
This rule has a grave impact on companies in some instances. "This makes it difficult to develop a swift response that reacts to news items or answer a sensitive subject in health that emerges unexpectedly," says Sonia Braham, a senior manager, media relations, Pfizer in Paris.
This provision has also hurt the bottom line for healthcare communications practitioners doing work in the country. "It has led to a huge decrease of promotion, having to plan six months in advance what should be presented by sales reps," says Isabelle Genin, MD of Chandler Chicco Companies Paris. "It's also given us less freedom in creativity and storytelling."
But the situation is not dire. PR agencies and in-house shops insist it's still possible to draw attention to important topics.
For instance, restrictions are less severe for digital communication toward healthcare professionals that are training related.
Shoring up comms
The industry is also working to bolster communications that focus on concepts related to social purpose and CSR, which are still major topics that can impact consumers' choices, according to Fabrice Préau, director of Edelman's healthcare practice in Paris.
"Exploring topics that resonate with people could show a new face of the industry," says Préau. "One that's more responsible, closer to citizens, and not just focused on profit, which is an image we need to change."
Pfizer, which often seeks to join or support major public health messages related to tobacco cessation, preventing cardiovascular disease, and the importance of vaccinations, is one company that embraces the idea, adds Braham.
Even with the increased scrutiny, doing business in the country is critical due to its size, says Lestra Laurence, director of public affairs and communications at Boehringer Ingelheim in France.
"We continue to do business in France, but we have to change the image of the industry to regain some confidence in it," she says.