The UK’s healthcare providers are suffering from a new ailment
sweeping their consultation rooms. Known affectionately as ’jaw-drop
syndrome’, its main cause is the growing number of patients who wave
print-outs of health information from the internet, then ask a string of
sophisticated questions about their condition and possible
As patients increasingly hold the medical profession in less awe and
become more health-literate - largely through the internet - some fret
about the changes to the patient-doctor relationship. They fear that the
UK will turn into a nation of desk-thumpers, demanding inappropriate
treatments from their GPs on the basis of misinformation. Others are
more upbeat and view what is widely being hailed as the rise of patient
power, as an opportunity to address broader audiences.
So where is this new patient assertiveness coming from? Is it simply
that more widely available medical information and tighter NHS budgets
mean that people feel they can no longer trust the public sector with
This may be true in part, but there are other more complicated
For example, many point to the growing efficacy and organisation of
patient advocacy groups in voicing their opinions and concerns. Patient
champions span almost every therapeutic area, from respiratory problems
to mental health, and range from small one-man bands to national
charities and lobbying outfits. In recent years, many of these
organisations - particularly in areas such as cancer and HIV - have
exerted considerable pressure on public health policy.
But patient power has also grown through increased individualism and a
rise in consumer power in general .
’From John Major’s government onwards, we have had carefully-manicured
soundbites about people living longer and public sector finances being
stretched to the point where we can no longer rely on the nanny state,’
says Gareth Zundell, director of Harvard PR. ’The message coming through
from government has been that the individual has to take some
responsibility for their own health,’ he adds.
This has been delivered by investment in health education as well as
provision, and an emphasis on giving the public ownership of lifestyle
choices such as diet, exercise and smoking. This in turn has created a
hunger for medical information, which has been satisfied with a wealth
of health magazines, newspaper supplements, TV programmes and of course,
New research by the Gallup Organisation reveals that more than six
million people in Britain use the internet regularly to keep up-to-date
with the latest treatment options and medical information. Providing
access to other patients, drugs information and research, means that
health has recently overtaken pornography as the most popular reason for
surfing the web.
While the internet is a global resource, the past few months have seen a
proliferation of UK-based health information sites such as NHS Direct
(www.nhsdirect.nhs. uk), netdoctor (www.netdoctor.co.uk) and Dr Mark
Porter’s site surgerydoor (www.surgerydoor.co.uk).
Last December, Medicom UK, which publishes titles including Medical
Monitor and Essentials, launched its healthinfocus web site (www.
healthinfocus.co.uk), which aims to provide a comprehensive information
service for patients, carers and professionals.
This enables users to catch up on on a vast range of topics from the
common cold to Crohn’s disease, whether to look for basic information
about a condition and its management, or the latest clinical
To ensure the credibility of the Medicom site and its relevance to the
UK health market, a dedicated team of NHS doctors write all the on-line
articles, and information on the site is peer-reviewed by an editorial
board of health professionals.
’A problem is that there are many health web sites that purport to
contain useful information, yet many of them contain statements that are
misleading or dangerous,’ says healthinfocus medical director Dr Peter
In addition, to guarantee that patient information needs are met,
healthinfocus has enlisted the support of over 30 of the top UK patient
support groups and medical charities. These include Breast Cancer Care,
the National Osteoporosis Society, and the Alzheimer’s Society.
Another recent development is the increasing access to health
information delivered to consumers by e-pharmacists. On the surface,
this would appear to be a somewhat alarming trend, combining commercial
interests with public health. For example, allcures (www.allcures.com)
which was launched by cScape on 20 January as the UK’s first
full-service on-line pharmacy, will soon handle both NHS and private
prescriptions. But the site carries a warning to use its information as
a supplement rather than a substitute for the expertise of other
healthcare professionals. And according to cScape marketing manager
Theresa Clifford, the company has been working closely with the Royal
Pharmaceutical Society to establish an ethical pharmacy model and iron
out the loopholes for potential drug abuse.
However, there is no doubt that a little knowledge can be a dangerous
thing. Judith Atkins, director of healthcare at Shandwick, says: ’A lot
of information is put out by amateurs, and the internet panders to
hypochondriacs.’ She cites the recent case of a woman suffering from ME,
who on the basis of information gleaned from the web, decided to perform
some DIY brain surgery.
’However, being better informed does help people to be more involved
with their healthcare and have more of a dialogue with their health
provider,’ adds Atkins.
’For instance a middle-aged man with high blood pressure who is
prescribed a certain brand of beta-blockers which may cause impotence,
can go back to his GP, ask about alternatives and negotiate his
For pharmaceutical companies and their PR people this offers huge
opportunities for bringing powerful new audiences into the marketing
loop. Instead of simply pushing treatments at the purchasers and
decision-makers within the NHS, patients can do some of the work for
In part this can be accomplished by ensuring that all the relevant third
parties, such as advocacy groups and on-line information services have
the latest up to date drug information. But increasingly, pharmaceutical
companies are forming partnerships with consumers.
’Allying with patients and patient support groups provides a powerful
way of communicating a company’s educational and product messages in a
credible and balanced way,’ says Mike Kan, director of Hill and
Knowlton’s UK health and pharmaceutical practice.
His team works with consumer groups in the cardiovascular, respiratory
and migraine treatment areas. In conjuction with client Roche, H&K has
also sought to address the often sophisticated concerns of HIV and Aids
patient groups worldwide.
’Our clients listen closely to consumers and are increasingly interested
in speaking their language and building strong relationships with
patient groups,’ says Kan. ’The benefits of this are enormous, ranging
from building greater trust through to increased patient compliance with
However, although interests may be mutual, advocacy groups are becoming
more demanding in terms of what they want to achieve. Whereas three or
four years ago, some organisations may have agreed to a certain amount
of rubber-stamping of pharmaceutical companies’ activities simply to
gain exposure, this in no longer the case.
Last September, Cohn and Wolfe was briefed by Eli Lilly to develop and
implement a UK communications strategy to raise awareness of
premenstrual dysphoric disorder (PMDD), more commonly known as severe
PMS. This was mainly to strengthen the position of Prozac as the first
prescription medication to receive a licence indication for the
treatment of PMDD.
The agency secured endorsement from appropriate third parties, such as
celebrity Sharron Davies and key opinion leaders, including a group of
four UK physicians. However, a vital component was the support of the
National Association for Premenstrual Syndrome (NAPS) which provided
independent consumer support and media-friendly case studies.
The benefits of this relationship were two-way. A partnership was formed
to develop a consumer-focused PMDD awareness leaflet, positioning the
condition as severe but treatable. This leaflet was endorsed by NAPS and
carried its logo, but also carried patient information about how to seek
help for PMDD from a GP, a helpline number and details of the NAPS web
But while the focus is increasingly falling on the consumer, drugs
companies cut the health professionals out of the communications mix at
Angie Searle, head of healthcare at Cohn and Wolfe, says this is a
lesson the US was forced to learn with the introduction of
direct-to-consumer (DTC) advertising. ’All this money was spent on
pushing treatments to consumers, but companies forgot to talk to
doctors, so they carried on prescribing the products they knew best,’
Cohn and Wolfe’s PR activities for prescription drugs are split with
around 60 per cent dedicated to communicating with the consumer, and 40
per cent on traditional NHS and medical audiences.
’We believe that patients are going to be the driver for future
healthcare PR, but it is important to also educate the health
professionals,’ says Searle.
As the Government increasingly struggles to foot the NHS bill,
predictions are that a strong Labour showing at the next election will
usher in a new era of co-payment for prescription drugs. The thinking
goes that if patients are self-funding their treatment, then they
deserve to know exactly what they are buying.
Richard Marsh, head of the health team at public affairs agency
Government Policy Consultants, stresses that it is important not to
confuse the issue of DTC advertising with well-informed patients. ’The
pharmaceutical industry still has to do some convincing of patient
groups in the area of DTC,’ he says.
Clearly a major concern is that the bottom line for the drugs industry
is commercial benefit. But according to Marsh, this does not affect the
mutual interests of drugs companies and patients. ’Pharmaceutical
companies have a legitimate point of view in aligning themselves with
patients, as society has no right to deny the public access to
information about drugs,’ he says.
However, Marsh is anticipating with interest how the political agenda
accomodates more patient pressure in the immediate future. ’The
Government has a centralising tendency, so over the next five years we
will see the extent to which this clashes with patient power,’ he
But in the long-term, Jennie Talman, managing director of healthcare
specialist Chandler Chicco, believes the principles of healthcare PR
will stay the same.
’In most cases, the ultimate aim of a communications strategy for an
ethical product is to influence the consultation between the patient and
doctor to achieve a particular outcome,’ she says. ’The best outcome for
PR is to influence the consultation by facilitating dialogue between
doctor and patient. We need to work hard at finding a common language,
which enables us to communicate product benefits in a meaningful
It is clear that the healthcare industry will have to devote more
attention to patients in the future. With the growing power of the
internet as a global information resource, this is likely to throw up
all sorts of legislative, security and crisis issues. But as key
developments benefit the interests of the consumer, and those consumers
grow in power, these will need to be targeted in parallel to the health
WELLBEING ON THE WEB: ON-LINE SELF-DIAGNOSIS
healthinfocus is produced by Medicom International.
It is foremost a web site aimed at doctors, as an in-depth database of
medical information. However, it offers jargon-free advice and
information for the public and is affiliated to NHS Direct.
The site sections are: News Focus, Search this Site, Chat focus, Quick
Browse, Supporter Focus and Clinical Focus. Medical terms are given
jargon-free explanations and patient support groups can be tracked down.
The site has an advisory board of some 40 patient support groups.
NHS Direct is the National Health Service’s 24-hour telephone advice and
information service. It is supported by NHS Direct On-line.
Its sections are much the same as other sites, although the Healthcare
Guide with its Symptom Guide provides the most user-friendly means of
self-diagnosis. A map of the human body is shown, and when the cursor is
clicked on a particular area a series of questions are asked. Once
answered, a diagnosis and treatment suggestion are given or the user is
told to phone NHS Direct.
The site is very much geared to someone with no medical knowledge. It
also includes an A-Z guide to the NHS - including advice on complaint
allcures.com is an Essex-based on-line pharmacy, offering advice on
medical problems and treatments.
The site is divided into six main categories, including a pharmacy, a
health information section, a beauty products zone and an advice centre
on alternative remedies.
The health section allows browsers to search an A-Z of diseases. It also
provides news on health and pharmaceutical issues. The pharmacy section
matches medical conditions to the drugs used to treat them and provides
information on the products. The site also includes an Ask the Expert
The NetDoctor homepage shows a series of banners for the various
categories available. As well as the obligatory diagnosis, drugs and
definition areas there is also a section on sex and relationships.
There is a guide to pregnancy and childbirth and parents can direct
questions about their children’s health to the site. Ask the Doctor
links users toDr Hilary Jones. There are links to many resources for
medical professionals, including the Medline search engine.
SurgeryDoor is produced by Intouch and Health Limited, suppliers of
touchscreen health information kiosks for the NHS. The site reflects
this with a series of ’doors’ for the various headings. Its editorial
team is led by TV’s Dr. Mark Porter. The main areas are Medical Facts,
Healthy living, Travel Health, Alternative Medicine and Health
Multi-store. The site also has news and other services, including
information on immunisations and patient experiences.