FOCUS: HEALTHCARE PR; Taking a holistic approach to health

INITIATING DIALOGUE: Healthcare professionals and pharmaceutical companies can benefit from advisory boards BREAKTHROUGHS: Communications makes its mark in education, clinical trials, and debate in the NHS TRADING PLACES: How the larger agencies have snapped up smaller specialists to get into the healthcare sector

INITIATING DIALOGUE: Healthcare professionals and pharmaceutical

companies can benefit from advisory boards

BREAKTHROUGHS: Communications makes its mark in education, clinical

trials, and debate in the NHS

TRADING PLACES: How the larger agencies have snapped up smaller

specialists to get into the healthcare sector



PR plays a unique role in bringing together the views of patients,

pharmaceutical companies and the medical profession. Hilary Freeman

reports



The pharmaceutical industry presents PR agencies with a unique

challenge. They must target their campaigns and marketing initiatives

not at the customer who will use the drugs, but at the prescriber. This

odd commercial situation has created a tripartite relationship - between

the healthcare PR agencies, their pharmaceutical clients and the

healthcare professionals working in relevant therapy areas.



Healthcare PR agencies have developed a number of tactics to deal with

the dynamics of this unusual relationship. With specialisation in

particular therapy areas now the norm, education has become the key.

Agencies aim to attract opinion leaders in the medical establishment who

will both impart their knowledge to clients and are open to new ideas

and developments in their field. Over the last ten years, many agencies

have begun to use advisory boards, teams of experts who are often culled

from the agency’s contact list.



Specialist healthcare PR company, Interaction has set up advisory boards

across its account base which includes Wyeth Laboratories. Comprised of

eight to ten health specialists, each board meets at regular intervals

to discuss individual therapy areas, to examine new clinical papers and

to provide direction for product development and marketing initiatives.

The Tunbridge Wells-based company also uses its advisory experts to help

write newsletters, which are sent to GPs, and articles for the medical

trade press.



Marian Byrt, account consultant at Interaction says advisory boards help

the relationship between the manufacturer and the medical professionals,

with the PR company acting as an intermediary: ‘The client gets the

educational benefit of expert opinion and approval for new products and

the members of the board get the chance to get together with their peers

to discuss patient issues. Our advisory boards have now become almost

autonomous,’ she says.



Byrt believes advisory boards are provide a more effective marketing

medium than the promotion of products in isolation. ‘The meetings guide

our promotional work, leading to actions which are more appropriate to

the market place. It’s a formula which works well.’



Martin Ellis, director of Cohn and Wolfe’s healthcare division says his

company uses a variety of different formats for advisory board meetings.

In the pre-marketing launch phase of the drug, an advisory board will be

used to confirm the positioning of a product in the marketplace and to

advise clinical research. In the post-marketing phase, an expert panel

can keep an on-going check on marketing activity and help the

pharmaceutical company increase awareness of particular conditions by,

for example, endorsing particular disease weeks, such as the recent

National Osteopathy Week.



Ellis says using medical experts gives drug companies public

credibility. ‘The public will not believe a company spokesman, but they

do believe an independent third party expert.’ But he warns that it may

not be wise to rely on medical professionals: ‘Any agency needs to be

acutely aware of the time constraints and pressures on opinion leaders.

You should not make unreasonable requests. Planning is the key.’



The use of advisory boards is condoned by the Association of the British

Pharmaceutical Industry. Richard Ley, the assocation’s head of media

relations, says that they give drug companies a better understanding of

the needs of customers: ‘The more that is done to maintain dialogue - or

in this case, trialogue - the better,’ he says. ‘Issues such as cost can

be raised and discussed in a useful environment.’



PR companies have also become involved in drug-company sponsored post-

graduate education authority seminars for GPs, often using their

advisory board panels as speakers. Such seminars enable the consultancy

or in-house department to run a product-oriented healthcare campaign,

while the GP gains points for continued approved training. Cohn and

Wolfe, for one, has produced a document on how to gain PGEA

accreditation and provides speakers and materials for seminars and

disease awareness groups at both a local and national level. It sends

out mail-shots to GPs, hoping to attract those with a specific interest

in the disease area -potential new opinion leaders - rather than those

who just wish to tot up more points. Some agencies offer drug company

sponsored training courses, teaching doctors presentation, business and

editorial skills.



The Royal College of General Practitioners has strict guidelines on

sponsorship, preferring to offer its own seminars where possible.

Although sponsorship means it does not have to charge delegate fees, it

is wary of associating its name with particular pharmaceutical

companies. This cautious attitude is prevalent across the medical

establishment. Many doctors feel that they are already overloaded with

advertisements and mailings from drug companies and are unable to

distinguish between carefully marketed literature and what they perceive

to be ‘junk mail’.



Dr Joe Collier, clinical pharmacologist at St George’s Hospital Medical

School, has published papers on the relationship between the drug

industry and the medical profession.



He says PR initiatives may not be beneficial in this respect: ‘Doctors

are wary of the advice given by drug companies and they are wary of PR

people. Focus groups have been going on for years - I don’t think they

make any difference. They just muddy the waters. The closer a doctor

gets to the industry, the more difficult it is to be independent.’



Dr Collier concedes that the relationship has improved in recent years:

‘Historically, drug companies have led doctors by the nose. But, as

doctors have become more questioning, the industry has begun to put the

relationship to rights. However, it is in many respects at an impasse.

Doctors and drug companies are going down two separate tracks - it is

difficult to see how they can work together.’



Dr Peter Fellowes, chairman of the BMA’s prescribing sub-committee is

more philosophical. He says that without drug company sponsored

educational packages, there would be no seminars or training for doctors

because the Health Service does not have the funds to run them.



‘While doctors must be aware of the pharmaceutical industry’s commercial

motives, co-operation is common sense,’ he says.



Dr Fellowes favours the open approach which PR agencies bring to the

relationship between pharmaceutical companies and doctors. He is

concerned about direct marketing initiatives which US-based

pharmaceutical companies are attempting to bring to the UK: ‘Two US

companies are attempting to set up a system by which they can pay

pharmacists to supply the details of individual doctors’ prescribing

habits to pharmaceutical companies. They claim this would improve the

targeting of literature. But it raises concerns over confidentiality and

a possible flood of unsolicited advertising.’



Whether such initiatives take off, the globalisation of the

pharmaceutical industry, together with changes in the structure of the

NHS means healthcare PR agencies are under increasing pressure to come

up with novel schemes for their clients. Advisory boards are becoming

more and more common, leading to competition for experts.



Neil Kendle, managing director of Fusion, says the increase in expert

panels has made the market better for doctors, but tougher for PR

companies. ‘When we first started, our aim was to communicate clinical

matters. In order to attract doctors to meetings, we began to offer

training in presentation, business and editorial skills,’ he says. ‘With

the changes in the NHS, trusts now offer such training. We will have to

find another way to attract doctors to seminars and on to boards.’



The restructuring of the NHS has also brought new opportunities: ‘It has

broadened our range of targets,’ says Kendle. ‘PR agencies used only to

be interested in prescribers, like doctors and practice nurses. Now the

people involved in decision making are over and above the prescribers -

senior hospital management, the medical advisers and clinical directors.

They are what interest us now.’



Inform: Pursuing improved communication in patient trials



Inform, a clinical trial patient recruitment service launched by Cohn

and Wolfe in November 1995, is the first project of its kind in the PR

healthcare market. Unlike other PR educational initiatives it applies

proven communication disciplines to the clinical trials phase, prior to

the pre-marketing stage. While most industry protocols are data driven,

Inform is patient-centred.



Information in the Research of Medicine was created after extensive

research into the problems of patient recruitment and retention for

clinical trials. Cohn and Wolfe concluded that the market needed a

‘tangible, recognisable and credible brand’ to capitalise on new

business opportunities among pharmaceutical companies. It devised

Inform, a core communications package containing generic patient and

investigator materials and activities. Contents include a patient

information leaflet on clinical trials, an audio tape with a study

investigator answering a patient’s questions on clinical trials, press

material and overhead presentations for use at local patient association

meetings.



Inform’s appeal lies in its flexibility. The protocol package is

marketed to potential clients who can ‘pick and mix’ and tailor the

available tools and techniques to meet their specific trial

requirements. Cohn and Wolfe works closely with the clinical research

associates and local investigators of the pharmaceutical company to

define local issues and help the investigators communicate with GPs and

patients in the trial region.



Martin Ellis, director of Cohn and Wolfe, believes that structured

communications initiatives like Inform are essential to the success of

clinical trials. ‘If the industry continues its current practice -

independent of public perceptions and environmental factors - it will

fail to overcome the barriers to recruitment, retention and compliance,’

he says.



Proof of Inform’s success lies in Cohn and Wolfe’s expansion, both in

terms of staff numbers and fee income, since the service was launched.

It helped the agency to achieve a 17 per cent increase in fee income in

1995 and should account for 50 per cent of agency income by the end of

1996. Inform has been used in projects for DuPont and SmithKline Beecham

and has won Cohn and Wolfe several retained clients across diverse

disease areas. The agency claims that over 50 per cent of UK

pharmaceutical companies have requested further information about

Inform.



SmithKline Beecham plans to use Inform to support all clinical trials in

the UK. Dr Martin Woollard, head of research and planning at SmithKline

Beecham says: ‘Inform is a very clever, cost-effective yet simple

solution to our problem.’



Case study: Bates uses software to play doctor



Bates Healthcom, part of the Bates advertising group, is a ‘dedicated

healthcare agency’. It covers the broad spectrum of advertising,

marketing and PR and is involved in clinical trials, in forming ties

with opinion leaders and in the education of healthcare professionals.



Healthcom’s chairman, Mike Lees recognises that ‘doctors don’t like

being educated after they’ve left college’. As a solution to this

problem, the agency has come up with an award-winning interactive

software package, developed for Lundbeck, a pharmaceutical company

specialising in psychiatric medicines, in conjunction with psychiatrists

at the University of Southampton. Designed to be used by GPs in local

workshops, the initiative takes the advisory board format one stage

further - the knowledge of the opinion leaders is contained within the

software.



The package was developed in response to evidence that GPs have

difficulty in diagnosing depression. Its aim is to improve doctors’

diagnostic techniques and management strategies, using both drug and

non-drug options. In real time, and with digital sound and pictures of a

patient, it re-enacts a real-life consultation, giving the doctor the

opportunity to ask questions to which the patient replies. The programme

allows the doctor to examine the patient, suggest a diagnosis and

prescribe a range of drugs. He can even send out a health visitor.



When the doctor has finished his consultation, his performance is

assessed and he is told where he is going wrong. By typing in key words,

the package can also be used as a psychiatric medical dictionary,

teaching the doctor about psychiatric problems and the uses and abuses

of drugs, thereby refreshing his memory and bringing his knowledge up to

date.



Lees says the programme’s success lies in its evocation of a real life

consultation. Rather than sitting around a board table half listening to

discussion, a doctor becomes emotionally involved with the subject. It’s

also fun.



Lundbeck’s products are not overtly promoted in the software package.

Lees says this is the key to pharmaceutical marketing: ‘The best form of

promotion is covert. We don’t have to spell out that Lundbeck’s drugs

are the best. If the doctor is educated well, he will come to this

conclusion himself,’ he says.



Since its launch in January, the package has been presented to GPs at

over a thousand meetings and was praised at the World Psychiatric

Association Conference in Madrid. The agency plans to launch interactive

educational programmes across a range of therapy areas.



Case study: MAC initiates debate in the NHS



Medical Action Communications, the healthcare market leader, generated a

fee income of pounds 4.47 million last year. It puts its success down to

the consistency of its approach, good business planning and its in-house

medical and scientific team. Forums for Debate, a concept developed for

client SmithKline Beecham, is an example of the agency’s formula for

success, showing how a well-planned advisory board model can bond agency

and client and improve relations with NHS customers.



MAC devised Forums for Debate to give SmithKline Beecham an opportunity

to discuss issues directly affecting the planning and delivery of

health care with leading clinics and decision makers. Its aim was to

explore how all the parties could work together to achieve optimal

patient care. MAC determined topics for debate, identified appropriate

contributors and structured the meeting.



Chaired by microbiologist, Professor Michael Emmerson, the first

national debate was held in May 1995 and examined the role of

purchasers, providers, the industry and the patient in developing best

practice in infection management. Representatives present included the

chairman of a hospital trust, the director of the Patient’s Association,

fundholding and commissioning GPs and the marketing director of

SmithKline Beecham. The debate covered the needs of patients, rational

prescribing policies, diagnostic services, effective protocols and

working alliances between the various parties and industry.



Stephen Bullock, managing director of MAC, says that the meeting

exemplified the new direction being taken by the pharmaceutical

industry. ‘Traditionally the industry has always played the passive

sponsorship role,’ he says. ‘The difference about Forums for Debate is

that we placed our client at the table as a key player in the debate.’



Healthcare representatives are optimistic about future relationships

with the pharmaceutical industry. Linda Lamont, director of the

Patient’s Association says: ‘Information and education is where the

alliance comes in. The pharmaceutical industry has a hugely important

role to play here.’



MAC produced a report and a kit containing a video of excerpts from the

national debate for regional key account managers to use in setting up

local debates. MAC believes Forums for Debate has helped develop

important relationships with new NHS custom-ers and has raised the

perception of SmithKline Beecham to one of ‘Partnership beyond

Prescription’. The agency is now working with advisory boards at

international level.



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