FOCUS: HEALTHCARE PR; Swallowing the bitter pill of drug legislation

PHARMACEUTICALS: Restrictive legislation makes it difficult to promote new drugs, regardless of their benefits HOSPITAL PR: Communicating changes to NHS and private hospitals without incurring the wrath of the public PRICE FIXING: Small pharmacies come under threat by cut price OTC medicines being offered by retail giants

PHARMACEUTICALS: Restrictive legislation makes it difficult to promote

new drugs, regardless of their benefits

HOSPITAL PR: Communicating changes to NHS and private hospitals without

incurring the wrath of the public

PRICE FIXING: Small pharmacies come under threat by cut price OTC

medicines being offered by retail giants



As PR agencies seek to build global brands, a mass of industry

regulations stand between pharmaceutical companies and patients with a

growing interest in their own healthcare. Robert Gray reports on the

international ethical and OTC markets



One can draw an interesting parallel between what has already taken

place in the hi-tech sector and what is now happening in the

pharmaceutical industry. While IT giants such as Microsoft, Compaq and

IBM now target the consumer directly as well as the corporate market,

the same holds true for the manufacturers of ethical drugs (that is,

prescription only medicines rather than over the counter products) -with

the important distinction that unlike the technology companies they

cannot exhort consumers to buy their particular brand.



Under the Association of the British Pharmaceutical Industry’s (ABPI)

code of practice pharmaceutical manufacturers may only talk to the

public about the benefits of a particular class of drug as part of a

disease awareness campaign. It is with doctors and other medical

professionals that they must establish the specific benefits of their

products if they are to see them used widely - thereby recouping the

often huge costs that go into research and development of an ethical

drug.



‘It’s become more difficult to promote to prescribers, and particularly

GPs,’ says Manning Selvage & Lee director of healthcare Europe Howard

Godman. ‘The culture has changed. They’re getting cost- conscious and

branded products are taking a hit as they look at their value against

generics.’



In a climate where cost-benefit analysis is of growing importance,

pharmaceutical companies often need to make a financial as well as

therapeutic case for their drugs. A product may find favour with a

doctor even if it initially costs more than another treatment for the

same condition, when it can be shown that in the long term it will be

cheaper because, for example, it reduces the number of visits a patient

has to make to his or her medical centre.



‘Sometimes it’s a case of constructing an argument that a new medicine

has a place, even if it’s more costly,’ says Charlene Bargeron, managing

director of pharmaceutical communications specialist Greenlines.



The question of targeting consumers when promoting an ethical product

remains a vexed one. The consensus is that the ABPI is right to bar

pharmaceutical companies from promoting their brands to the public. But

at the same time one has to acknowledge the growing interest the public

is taking in personal healthcare issues.



There is a continuing trend towards patient empowerment and, to some

extent, the drugs companies are being put under pressure to provide more

information on diseases and how they can be treated.



‘We mustn’t do anything to encourage patients to go to their doctors

and ask for specific brands,’ says Fusion Communications managing

director Neil Kendle.



‘I think that’s absolutely right. But everybody is accepting that times

have changed and that patients have a right to be involved in

therapeutic decisions,’ he adds.



All well and good but for the owners of ethical brands, communicating

with the public can be something of a minefield. As well as being

limited to talking about classes of drugs rather than specific product’s

names, manufactureres cannot allude to a benefit. A drug either has a

therapeutic benefit or not. If a benefit is claimed in media relations

material or literature for the public it has to be substantiated by the

results of clinical trials. Moreover, it is vital that drugs companies

do not raise false expectations among disease sufferers.



‘One of the key ways to overcome regulatory barriers is to use the

independent voice of third parties such as patient groups and medical

professionals,’ says Harvard Public Relations associate director Barbara

Rayner.



On behalf of its client Ferring Pharmaceuticals, Harvard works closely

with ERIC (the enuresis research and information centre) on the

implementation of a bedwetting information programme comprising case

studies and treatment advice.



Patient empowerment has meant that such support groups have recently

acquired a great deal more clout than ever before. In fact, in America

some of the pre-eminent patient organisations have become known as

advocacy groups, reflecting their lobbying power and the influence they

bring to bear on the medical profession. Persuading a patient support

group to champion a product or class of drug can be a tremendous fillip

for a pharmaceutical brand owner.



Drugs companies and patient groups also can, and often do, team up

effectively to increase awareness of a disease. A good example of this

is the Poster Awareness Campaign for Epilepsy (PACE), a joint initiative

between Marion Merrell Dow and the International Bureau of Epilepsy,

promoted by Burson-Marsteller. The campaign centred on a pan-European

poster painting competition that drew entries from over 200 people with

epilepsy.



The entrants were asked to produce posters on the theme of

‘independence’ in epilepsy. Delegates to the fourth European Conference

on Epilepsy and Society ‘Epilepsy Now’ in the Netherlands picked the

winners who were given cash prizes and saw their work reproduced in

poster and postcard form and displayed in clinics, pharmacies and

doctors’ surgeries as the centrepiece of the awareness drive.



Cohn and Wolfe has recently tackled awareness-raising in the ethical

sector by applying the classic consumer marketing technique of

advertorials. On behalf of its client Glaxo Wellcome, which recently

launched Pylorid, a treatment for h.pylori the bug associated with

stomach ulcers, the agency produced full-page advertorials for Hospital

Doctor and Pulse - a new departure for the medical journals.



In the over the counter sector, meanwhile, manufacturers are having to

pull off a communications balancing act that allows for innovative

consumer marketing that does not detract from a responsible corporate

image.



The trend towards self-medication that has seen consumers take more

control over the medicines they take has also brought a growing

awareness of the names behind the products. Unsurprisingly, drugs

companies are reluctant to take risks with their names.



‘It is imperative that the pharmaceutical companies don’t lose their

white coat authority,’ says Pippa Sands, deputy managing director of

Biss Lancaster and head of its new healthcare and consumer PR company

Sandpiper Communications.



‘That said, some of the techniques that one might use for an ordinary

household product can be interpreted to suit the need of a

pharmaceutical brand. But marketing to the consumer requires a certain

kind of language and flexibility which is wholly inappropriate for the

profession.’



As with brand owners in other sectors, many of the pharmaceutical

companies have sought to create global products. This has proved more

difficult to achieve than is the case with products such as sportswear

or fizzy drinks.



In part this is due to the nature of the products and the regulations

governing their advertising and promotion. But in the OTC market there

can be a tendency for consumers to stick with remedies with which they

are familiar - so building a global brand takes a lot of time and

effort.



‘The multinationals are really trying to take their brand names and make

them work in other countries,’ says Proprietary Association of Great

Britain commercial affairs manager Alison Williamson. ‘But it’s tough in

the European OTC market where a lot of the products have grown up over

generations and have become traditional names.



‘There aren’t that many over the counter products that have been

globalised. If you look at the US some of the popular product names

there are very different to the ones you get in Europe.’



Robin Wright, managing director of Edelman Medical Europe, takes the

view that global marketing departments, especially at US pharmaceutical

companies, still have a ‘lack of understanding about Europe per se and

its different regions and cultures’.



While Jonathan Levy, a partner in Advisa Medica which has been doing

international work for client Boehringer Mannheim, believes

globalisation is easier if you’re ‘working on a common brief for

everyone, even if the local affiliates complain’.



It is a theme which has been developed by Burson-Marsteller associate

director Jennie Talman. ‘Despite the lack of harmony in European OTC

marketing legislation the growth of international brands is inevitable

in the long term,’ she says.



And, given the complicated messages that need to be conveyed, public

relations is sure to play an important role in establishing

international pharmaceutical brands and their values in the eyes of the

consumer - whether that consumer be in Milwaukee, Manchester or Madrid.



Internet: Spreading knowledge on the Web



Last year specialist pharmaceutical PR consultancy Complete Pharma

splashed out on an ‘expensive server’ enabling it to serve its clients’

Internet needs. Now, according to managing director Scott Clark, it is

working with all its major clients on ‘Internet investigation’.



As Complete Pharma’s clients include many of the world’s leading

pharmaceutical companies, including Glaxo Wellcome and Pharmacia and

Upjohn, one can assert categorically that pharmaceutical companies are

now taking the Net very seriously as a communications medium.



The first fruits of Complete Pharma’s work is the International Prostate

Cancer Reporters Club, a Web site for medical editors and correspondents

carrying news and research on the condition.



The site, which launched at the end of October, was created for client

Zeneca to help position it as an authority on prostate cancer. The

company has two treatments for the disease: Zoladex 10.8 and Casodex.

‘This is not a way to get around the ABPI code of practice,’ says Clark,

who insists that claims still have to be backed up by clinical trials.



Access to the site is restricted to prevent unauthorised use. Onlybona

fide medical journalists are given a password.



Clark adds that it is important to use the ‘interactivity’ offered by

the Net rather than viewing it simply as a means to display an

electronic corporate brochure. Pharmaceutical companies can, he says,

boost their standing among the medical profession by helping facilitate

the treatment debate.



Another recent Internet development has seen German media giant Burda

Medien launch its Health Service Online Web site to doctors in Germany.

Burda plans to make it available across Europe late this year.



The site will include information on medical products, conferences,

research and discussion forums. Also within the pharmaceutical sector,

the well-regarded publication Chemist & Druggist now has its own page on

the Web.



But it’s not all plain sailing in cyberspace. Fusion managing director

Neil Kendle says one of his clients has been having problems with

someone who has been disseminating material on the Net criticising one

of its products.



Pharmaceutical companies should see the Internet as a chance to

communicate proactively with their target audiences. But they should

also be ready to respond quickly should anyone take it upon themselves

to traduce one of their drugs on the network.



OTC medicine: Price-fixing battle rages on



Asda’s move last October to discount by 20 per cent the retail prices on

its branded vitamins has sparked what promises to be a battle royal.



The move was in contravention of resale price maintenance on

medicaments, the legal price-fixing agreement which allows manufacturers

and wholesalers to set minimum prices for over-the-counter medicines

like analgesics, antiseptic creams and health food products.



As was widely reported at the time, vitamin companies Seven Seas and

Roche served an injunction on Asda, causing the supermarket chain to put

its prices back up. But by then Asda had already done enough to persuade

the Office of Fair Trading to announce a review of resale price

maintenance on medicaments.



‘We challenged retail price maintenance and will continue to challenge

it because we feel it wasn’t allowing us to offer the lowest possible

prices for medicaments,’ says Asda PR manager Sue Finnegan. ‘It’s the

last area where retail price maintenance exists, which shows it is an

outdated law.’



When it last looked at ethical/proprietary products in 1970, the

Restrictive Practices Court made the Medicaments Order which allowed the

products to be exempted from the usual rules governing resale prices. At

the time the court argued that price fixing should be permitted for

medicaments as a way of protecting small dispensing chemists.



Today a broad alliance of manufacturers, wholesalers and small retailers

still believe strongly that RPM is needed as a safeguard for maintaining

the role pharmacies play in giving health advice to the local community.

Earlier this year, seven important industry bodies including the

Proprietary Association of Great Britain, Royal Pharmaceutical Society

of Great Britain and National Pharmaceutical Association banded together

to form the Community Pharmacy Action Group (CPAG).



In February CPAG hired Charles Barker to help it communicate its

arguments for keeping the status quo. The consultancy may also help the

individual organisations comprising CPAG to put forward their views to

the OFT.



‘There’s a common concern that the removal of RPM on non-prescription

medicines could impact on public health,’ says Charles Barker account

director Sue Ashe.



If the OFT can show their has been a prima facie change in circumstances

since 1970 the Restrictive Practices Court will be asked to look at the

situation again. Should this happen, it seems inevitable that a drawn

out battle between CPAG and Asda and its allies lies ahead. The outcome

of this struggle will determine how much consumers are asked to pay for

OTC medicines in the coming years.



Cipramil: Introducing a new name in anti-depressants



When Danish pharmaceutical company Lundbeck was preparing to launch its

SSRI antidepressant Cipramil to GPs in the UK last year it faced

something of a recognition problem. Although it had a well established

reputation for mental illness products on the Continent and among

psychiatrists in the UK, it was a virtual unknown among doctors

providing primary healthcare.



Moreover, it was entering a class which includes Prozac, the drug that

has almost become a byword for depression treatment.



Realising that a rigorous communications programme was necessary if its

drug was to make an impact, Lundbeck hired Burson-Marsteller to put

together a launch campaign. The nub of the programme was to make capital

out of Lundbeck’s credibility within the secondary care market ( among

psychiatrists) in order to get GPs interested in Cipramil.



Burson-Marsteller developed the concept of a ‘Head-to-Head’ roadshow - a

series of eight meetings in different locations across the UK based on

the format of the BBC television programme Question Time.



The meetings were chaired by broadcaster Nick Ross, who is identified

with mental health issues through his involvement with the schizophrenia

charity Sane, and took place in May/June and September/October 1995.



The panel of four speakers consisted of nationally recognised

psychiatrists and GPs with an interest in depression. They were asked to

discuss the problems facing clinicians in diagnosing and managing

depression.



‘We wanted to have a forum that was interactive and topical, where we

could get a lively dialogue going between the experts and the GPs,’ says

B-M senior account executive Anita Charles.



The meetings also enabled GPs to make contact with the psychiatrists in

their area - for some it was the first time they had met.



In all, about 400 GPs came to the eight Head to Head roadshow events. An

added attraction was that the event was given Post Graduate Education

Authority (PGEA) approval - which meant that doctors were awarded

continuing professional development education points for attending.



B-M followed up the roadshow by sending a newsletter on its contents

and the main issues relating to the drug to every GP in the country. The

newsletter featured very discreet branding for Lundbeck.



The Head to Head tour created awareness of Lundbeck and paved the way

for the launch of Cipramil. Since its launch in the latter part of last

year, sales of the drug are understood to have topped pounds 1 million.



‘When a large pharmaceutical company like Eli Lilly launches a new

product it doesn’t have to worry about its name being recognised,’ adds

Charles. ‘But in Lundbeck’s case it needed to make its name known to

GPs.’



Case study: Swallowing the Diflucan pill



Pfizer Consumer Healthcare found itself in an unusual position last

October when it was awarded an OTC licence for its vaginal thrush

treatment Diflucan 1. The product was only launched as an ethical in

1988, and at a mere eight years old was still seen as a relatively new

medicine to be making a POM to P switch.



Furthermore, it is radically different from the other thrush treatments

available from pharmacies - including Bayer’s market-leading Canesten -

which are all applied intra-vaginally, either in cream or pessary form,

whereas Diflucan is taken orally with only a single capsule required to

treat an occurrence of the condition.



At pounds 12.50 for a pack containing a solitary capsule, Diflucan 1 is

the most expensive OTC pill on the market and twice as expensive as its

direct competitors. So it was vital for Pfizer to communicate the

‘specific benefits’ of its product.



‘The proposition we were trying to communicate was that now you can

swallow a capsule for fast treatment of vaginal thrush,’ says Pfizer

Consumer Healthcare marketing director Malcolm Phillips.



Cameron Choat and Partners was brought on board to target the women’s

media, especially publications with a high readership among Pfizer’s

core target market of 25-35 year old ABC1 women. One of the key points

was to illustrate the ‘pride and status in use’ of opting for Diflucan

1.



Cameron Choat organised a consumer press launch at the Medical Society

with an expert in genito-urinary problems on hand to answer questions on

thrush and other vaginal problems.



A series of down-the-line radio interviews with the expert were also

arranged using broadcast consultancy Radio Lynx.



A Thrush Advice Bureau was established, in essence a telephone hotline

to a recorded message giving advice on thrush and details of where to

get a booklet on the condition. The bureau received a good deal of

editorial coverage and in January had 700 calls.



‘When we launched the product we saw there was no research done on how

thrush makes women feel psychologically, although plenty on the physical

symptoms,’ says Cameron Choat account director Sarah Birkmyre.



To rectify this, the consultancy drew up a list of questions on the

psychological impact of thrush which Pfizer then paid to have

researched. The findings, which underlined that some women can feel

depressed and dirty when experiencing the condition, were used as the

basis for generating further coverage and to underscore the importance

of successful treatment.



‘We’ve had superb coverage,’ says Phillips. Publications such as

Company, Cosmopolitan, Bella, Best and Woman have all given coverage to

the product.



Advertising for Diflucan 1 broke at the start of this year but by

December 1995 the product had already, claims Pfizer, achieved a 15 per

cent market share by value on the back of the PR surrounding its entry

into the over the counter market.



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