HEALTHCARE PR: A healthy relationship? - While UK pharma companies cannot market prescribed drugs direct to the consumer, it is possible to provide awareness. Maja Pawinska reports

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


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


DTC is a massive growth area for PR practitioners in-house and in

agencies, mainly driven by the wealth of information available on the


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


'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


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


'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


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


'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


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


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


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


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



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


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


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


No sales figures are available but, as a result of the campaign, sales

of inoculations against hepatitis A and typhoid increased.


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


- Companies should look at the medical and consumer credentials of

agencies - and how recent they are - and the commercial results of their


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.

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