In the not too distant future, if you had to take some medication at a particular time, the company that makes the drug could send you a reminder using WAP technology.
It would be a logical next step for an industry which has traditionally been one step removed from consumers, but which is now under increasing pressure to communicate with consumers, not just with healthcare professionals.
When pharma companies talk about direct-to-consumer (DTC), they're not necessarily talking about marketing products that consumers can buy off the shelf in Boots without a prescription.
The medical industry in the UK, unlike in the US, can't advertise prescription drugs to patients. It can, however, raise awareness of diseases and conditions for which it has developed a new product, and educate and encourage patients to present to doctors, asking about new treatments.
DTC is a massive growth area for PR practitioners in-house and in agencies, mainly driven by the wealth of information available on the internet.
Patients are super-informed about their own illnesses, maybe even more so than doctors, but the information available may not always be sound, and pharma companies are starting to realise that they need to view consumers as a new target group for their communications, albeit within a strict regulatory framework.
At Hill & Knowlton's pharma healthcare practice, managing director Wendy Mair says: 'Our clients are asking for DTC-style PR campaigns much more frequently than before as the power of the consumer and the high level of information about health is key to selling medicines.
'There is a definite move towards the US approach, although we have a long way to go and are governed by very strict rules and regulations for prescription medicines. The best method tends to be educational or disease awareness campaigns accompanied by strong case studies prepared to mention brands,' she adds.
In the US, DTC promotion and advertising is permitted, and is used to encourage consumers to see their doctor for a diagnostic test and promote price advantages over competitors. US advertising can also introduce a brand, indication or delivery system, and convert over-the-counter product users to use a prescription-only medicine.
The UK Medicines Act and an EU directive prohibit DTC marketing, but the US experience is driving an interest in this area within Europe. At Ogilvy PR Worldwide, group director of the health and medical practice Charles Butler says DTC in the US is misunderstood, and this has made it difficult for the industry to apply DTC strategies in the UK and Europe.
'DTC is not simply the ability to advertise or promote directly to consumers, but rather the ability to understand and leverage consumer activism and influence of treatment decisions,' he says.
Such is the sensitivity of the DTC issue in the UK, that in-house departments were generally reluctant to speak to PRWeek about promoting prescription drugs direct to a consumer base.
However, Schering head of PR Therese Wulff says: 'In the UK the pharmaceutical industry can't overtly promote (a prescription drug) to the public, but what we can do is to raise awareness of issues to the public and give doctors the solution'.
Code of practice
Within the Association of the British Pharmaceutical Industry (ABPI) code of practice, companies can provide basic product information, and responses to individual enquiries from the public and journalists.
Drug manufacturers can also make factual announcements, such as changes in licences and availability of new products, carry out education around a disease area, set up patient helplines, and provide financial information.
ABPI spokesman Richard Ley says the association is working to try and change what can and can't be said to the public. 'We'd like to provide greater information than we do, but the legislation would need to be changed.
'Patients are demanding more information, and with the internet it's easier to get hold of information which may be myth or misinformation rather than being sound. Consumers want to turn to manufacturers for the correct information, but they are not able to say anything,' he adds.
The ex-managing director of Hill & Knowlton's pharmaceutical practice, Karen Moyse, set up Kinetic Public Relations last November to provide strategic advice and training for pharmaceutical companies on how to do DTC. She says areas where people become confused include how long the launch period is, during which the brand name can be used under the ABPI code.
'Case studies are very important for bringing issues alive for journalists, but there is a grey area in terms of how much contact the pharma company can have with the case study, or whether it should be completely independent and provided by a doctor or an opinion former.' Schering's launch press releases, for example, contain one direct reference to the product and thereafter refers to it generically.
However, Cohn & Wolfe healthcare director Angie Wiles says the grey areas are welcome: 'Companies are starting to explore DTC in a more adventurous way, although many are still very risk-aware. We know what we can't do, but across Europe everyone is setting their own parameters in the grey areas, and that's a good thing, as we're pushing the boundaries further for clients,' she says.
The Shire Hall Group chief executive Margot James says this is a crucial part of the relationship between the in-house team and the agency: 'There needs to be an agreement made up-front as to what extent the pharma company is prepared to push the boundaries set down by the guidelines. There are very few companies who are really exploring the potential of the current environment as they are nervous about being seen to directly influence consumers to seek specific treatment.'
The pharmaceutical industry's general reluctance to comment on this issue would seem to reflect this. However, what pharma companies can do is educate the public about therapy areas and the health professional about specific products. Schering's January launch of emergency contraceptive drug Levonelle highlights the sometimes different view of the client.
The in-house department actually found itself trying to suppress information in the face of ravenous media demands prior to launch. Indeed, Wulff says that looking through her archives she came across an article dated 1993 announcing that over-the-counter morning after pills were 'just round the corner'.
Most practitioners in the UK don't think that even if there is a change in the law that we will ever see the US level of consumer drug advertising here. Wiles says: 'I don't think we'll ever see the dreadful US ads, which list all the side-effects and compare competing products. We're ready to learn the lessons from the US, but we are more reserved. Early on, money was piled into ads in the US but companies forgot to promote their products to doctors, and DTC advertising failed.'
This is backed up by James, who points out that however excited a pharma company may be about getting to consumers, a DTC campaign is pointless unless it is part of an integrated campaign of communications with the healthcare community. This is a salient point and one that the pharmaceutical industry has grasped. Without driving awareness and education to the medical community, how is a doctor going to be aware of a particular drug?
Wulff agrees that the medical community is a vital target audience: 'It is up to us to work with relevant doctors in a particular therapy area.'
Healthcare professionals should always come first and the proposition being communicated must be strongly supported. Many healthcare professionals are not supportive of increasing patients' knowledge as they believe this will lead to longer consultation times, specific and perhaps inappropriate treatment requests from the patients, raised false hopes, stretched budgets, and disease priorities not being addressed.
However, UK consumers are presently able to log on to a pharmaceutical company's US site and obtain information on a product.
'People are more curious and now demand information about healthcare', Wulff says. Unfortunately, there is plenty of misinformation available, which is another reason that leads both agency and in-house people to predict that the days of deregulation are not far off. If the consumer is being misinformed because regulation doesn't allow them to source accurate information in this country, the issue needs addressing.
There are plenty of other challenges for pharma companies in the DTC arena. At the heart of it for in-house teams is that DTC requires PR skills from the consumer area, as well as having the traditional expertise to communicate to the regulatory and medical community.
Similarly, a medical agency without much consumer pedigree will know exactly how to negotiate the regulatory hurdles of launching a drug, but it won't always understand how to communicate effectively with consumers.
Moyse believes that pharma companies have a way to go in terms of understanding consumer PR: 'Companies need to find out more about what motivates the group they are trying to target - what will grab their attention and make them take action. There's not a lot of understanding of the consumer's point of view, and how to shape it. They are not using classic consumer marketing techniques,' she says.
Moyse adds, however, that pharma companies are moving ahead of agencies in terms of their knowledge of this sector, and this is a concern that agencies have to address.
The consumer appetite for all things health-related is enormous, and patients are becoming much more empowered to become actively involved in their treatment.
Butler says: 'As companies invest vast amounts of R&D resources in a relatively small number of high potential markets, consumers become more important to the process. This hyper-competition in the pharmaceutical industry results in products with niche advantages which appeal to certain segments of patients, and for these patients companies want to ensure there are no barriers to access.'
And if pharma companies get it right, the rewards can be very high. In the US, DTC marketing has lead to a faster uptake in medicines in a number of areas, including new therapies in formerly untreatable or marginally treatable conditions such as Alzheimers.
According to Prevention Magazine in the US, 46 per cent of those who were exposed to DTC advertising felt better about the safety of their medicine. There has also been a positive response for drugs with lower risks or milder side effects where the number of patients who can tolerate them can be increased, and conditions with a history of being under-diagnosed or under-treated, such as depression.
The techniques used to target consumers are varied. Media relations will often be a significant element of a DTC campaign, but pharma companies can also work through third parties such as patient groups and disease charities to activate their membership. Helplines, websites, and patient leaflets and posters about disease areas may also be used.
AstraZeneca head of PR and communications Fiona Tigar, who has a background in consumer and pharmaceutical and healthcare PR, is running the first DTC campaign at the company since it merged a year ago.
'We have a disease awareness-raising campaign running at the moment about gastro-oesophagial reflex disease, or GORD. There is a poster campaign, a website, a patient booklet and a helpline,' she says.
'Patients are going to get the information from somewhere these days, but it's important that they get the right information - and information on websites might not be correct. DTC is a difficult area but we feel it is important, and it's an area of growth for us,' Tigar adds.
Disease awareness advertising is also permitted under the code, although this is not commonly used in the UK, according to Ralph Sutton, Burson-Marsteller head of healthcare.
'There is very little disease advertising in the marketplace. I've come from Australia, where it's commonplace, and the regulations are almost identical. In the UK, I think there's some concern about upsetting the medical profession - but if medics were educated about what companies are doing and why, in conjunction with public awareness campaigns, then they can be very well received,' he says.
The success of a DTC campaign is also easy to measure, because drugs companies can see patients taking action. Traditional media analysis can be used, but a campaign can also be measured with in-depth market research looking at an increased number of consultations taking place for a particular condition, and the number of patients who discussed something they had seen in the media with their doctor.
As for the future of work in this sector, Moyse is looking forward to pharma companies pushing the boundaries a bit further and approaching DTC in a more creative way.
'I think we will see more regional programmes at grassroots level, and even disease awareness direct mail and loyalty programmes. Glaxo has already done work in this area, keeping people who already take their asthma drugs up to date with developments,' she says.
Pharma companies are likely to be doing more interactive work with consumers, who are clearly open to using the internet for healthcare information.
DTC is a young area of PR, but those in the know are convinced that it's a real area of growth for in-house and agency practitioners. But until the industry is sufficiently deregulated, allowing a flow of accurate and ethically sound information, then it's a long way off being ready.
TRAVEL HEALTH AWARENESS CAMPAIGN
Shire Hall carried out a DTC media relations campaign last spring for SmithKline Beecham, supported by the Association of British Travel Agents (ABTA) and The Primary Care Virology Group.
The campaign was to raise awareness among travellers of potentially fatal diseases they could pick up, such as hepatitis A and typhoid.
Awareness of the need to seek vaccination against diseases like these is low, with less than 40 per cent of people seeking health advice before travelling.
The objectives of the campaign were to raise awareness of the importance of travel health, and to encourage travellers to obtain travel health advice from their GP a minimum of six weeks before travelling.
A high-profile media campaign was used to raise awareness of travel health among consumers during the run-up to the peak summer travel season.
The 'Ticket to Health' travel health awareness campaign was launched in May 2000 by ABTA and The Primary Care Virology Group, with Joanna Lumley fronting the campaign.
Support was also secured from a number of other organisations including The International Society of Travel Medicine, Patients Association, Scottish Centre for Infection and Environmental Health, Overseas Doctors' Association, the National Union of Students and the Royal College of Nursing.
The launch of the campaign was accompanied with market research data which showed the number of travellers leaving the UK without adequate protection, and who were putting themselves at risk of serious disease. ABTA also endorsed a travel health leaflet, 'Your guide to safer holidays', which was made available through all ABTA travel agents.
More than 50 journalists attended the campaign launch event with Joanna Lumley at London's Rainforest Cafe, including three film crews and six radio stations.
Media coverage included 11 reports on TV including the BBC and ITV lunchtime news bulletins, and there were 161 pieces of press coverage including most of the nationals.
Seventeen medical and 12 consumer publications also covered the launch, as did the newswires and various websites.
Forty-six per cent of the coverage contained four of the campaign's key messages.
No sales figures are available but, as a result of the campaign, sales of inoculations against hepatitis A and typhoid increased.
DTC - SOME GOLDEN RULES TO REMEMBER
Kinetic Public Relations founder Karen Moyse looks at some of the golden rules to running a DTC campaign:
- It's critical that the agency is involved from the beginning of any campaign, so they can advise a client on whether or not to use a consumer programme
- A company should ask whether a consumer programme is right for the product, think about the potential the campaign has, and what a consumer campaign would contribute to its commercial objectives
- What skills does a company need for the programme? The consumer element might be so small it can get by with a freelance, but if the consumer campaign is very important, does the agency have those skills
- Companies should look at the medical and consumer credentials of agencies - and how recent they are - and the commercial results of their campaigns.
If it's going to be a media programme, what do journalists think of the agency, and what do clients think 'off the record'?
- Companies should interview the individuals on the agency team - they have to really know their stuff. Not everyone needs to be a consumer expert, but the consumer person often needs to be senior so they will be respected and listened to by the rest of the team
- If the company has a brand where it will have to work hard to create interest, it should involve consumer people at a very early stage to get everyone thinking out of the box from the beginning
- Companies should getsomeone on board internally with consumer marketing experience so that theyknow what theyare buying.