RESPONSE MODE: Healthcare PR shifts gears - The recent terroristattacks have turned healthcare PR on its head, but many of the oldissues still need to be aired. Allen Houston reports

Much like it was for so many industries in the US, September 11 was

a defining moment for healthcare PR.

In the aftermath of the terrorist attacks, New York and its overburdened

hospital system desperately needed medical supplies, burn creams,

vaccines, blood, and human skin. Then, as the city's inhabitants tried

to make sense of their experiences and emotions, authorities recognized

the need for specialized mental health services. Healthcare, and the

effort to communicate its services, was very much at the center of the


And now with the presence of anthrax, the fear of further attacks, and

post-traumatic stress looming over US citizens, healthcare

communications remains at the forefront of the nation's effort to return

to "normalcy."

Reestablishing communications won't be easy given that the war on

terrorism has devoured the attention of the mainstream press, pushing

issues like the Patients' Bill of Rights, Food and Drug Administration

(FDA) approval of drugs, and other breakthroughs to the backs of

newspapers. But that doesn't mean these issues are going away, or that

healthcare won't play a more vital role in this new climate.

A lot was going on before the September attacks. After years of partisan

wrangling, the Patients' Bill of Rights finally passed the Senate and

House of Representatives, albeit in two different forms. The

McCain/Kennedy legislation, which allows patients to sue their HMOs for

an unlimited amount, passed the Senate on June 30. The more conservative

Dingell/Norwood legislation, which caps the liability of HMOs, scraped

through the House on August 2. The bills may differ in content, but at

least they present a starting point from which Congress can work.

The Pharmaceutical Research and Manufacturers of America (PhRMA), one of

the special interest groups supporting the Dingell/Norwood bill,

continues to hold press conferences and apply pressure on the state

level to spread the message that while it supports a Patients' Bill of

Rights, it also wants to ensure that pharmaceutical companies have free

reign in research and new drug discovery.

Reexamining healthcare's place

The events of September 11 literally placed the Patients' Bill of Rights

on hiatus. According to a poll conducted by USA Today, the bill has

dropped from the number-one to the number-five concern of Americans.

This may not last too long, though. As the country heads further into

the clutches of an economic recession, and more workers become

unemployed - and the number of uninsured rises - the need for a

Patients' Bill of Rights, prescription drug cards, and medicare reform

will grow louder.

In fact, President Bush has stated that his top concerns for the country

are his education bill and the Patients' Bill of Rights. And while

various press conferences and press releases may have been put on hold,

at least temporarily, the PhRMA says that it continues to move forward

with its agenda.

"Business as usual" is the message that many of these special interest

groups hope to convey to the public. "The nation's focus has obviously

changed, but we're optimistic that Congress will address these issues in

the near future," declares Jackie Cottrell, deputy VP of public affairs

for the PhRMA. "In times of crisis, people have a greater awareness of

their health, and we are ready to provide awareness so that people know

what's happening with regard to the Patients' Bill of Rights."

Citizens for Better Medicare, a group founded by the PhRMA, recently

mailed copies of Newsweek's special edition entitled "Health for Life"

to offices of members of Congress, along with a letter from PhRMA

president Alan Holmer telling policymakers to "use it when making

healthcare decisions." The group says it believes these issues will

become more relevant in the near future, and is prepared to continue

communication activities so the public understands its position.

Staying on top of the issues

Special interest groups representing the healthcare industry have been

plodding along, trying to adjust campaigns to fit the current climate,

but also pushing forward with issues that many of them admit will be

below the radar for the next few months.

One group that has continued full-throttle in the face of the shifting

landscape is Public Citizen, a nonprofit organization founded by Ralph

Nader. Public Citizen has been actively speaking with the media, sending

out releases, and writing letters to Congress to draw attention to the

fundamental flaws that it sees in the Best Pharmaceuticals for Children

Act, which the organization seeks to have extended for another year. The

law, which provides pediatric drugs for children, also opposes generic

drugs, which leaves some families unable to afford the care they


As special interest groups try to draw attention back to the issues of

Medicare and prescription drug benefits, some organizations are finding

that they have to be prepared for new crises that have arisen after the

September 11 tragedies. Families USA, a nonprofit group dedicated to

affordable healthcare, found itself having to respond to a Bush health

proposal in his economic stimulus package, which planned to transfer

$11 million from the State Children's Health Insurance Program to

recently uninsured adults.

The group issued a release and contacted the media to bring up the

problems with the stimulus package that might otherwise have been swept

under the rug by the national crisis.

Families USA also joined a coalition that included the Consumer

Federation of America, the National Consumers League, Public Citizen,

and the United Auto Workers. It also issued a press release and spoke to

the media about the ethical transgressions that it felt Newsweek had

overstepped by forging a special advertising relationship with the PhRMA

for its healthcare special.

"Access to responsible healthcare is more important than ever," explains

Jennifer Laudano, spokesperson for Families USA. "As the recession

deepens and more people become uninsured, and seniors stop taking their

necessary prescription drugs because they can't afford them, we feel

that our group has a commitment to go ahead with what we do."

Even for-profit healthcare organizations are staying the course.

Pharmaceutical giant GlaxoSmithKline, maker of Paxil and Zantac,

continued rolling out a campaign for its Orange Card, a prescription

drug card that provides a 30% discount to low-income seniors and the


Regaining national attention

Meanwhile, PR agencies are finding indicators that these issues, and

other important healthcare reforms, will soon return to the national


"We've received a lot of e-mail about breast cancer legislation," says

Susan Smirnoff, EVP and co-head of Ruder Finn's New York practice.

"There are all kinds of signs that the public is trying to get the

normal volume control back on these issues, and that they want Congress

to get back to business soon."

Even though Congress may have momentarily removed various healthcare

regulatory initiatives from the table, the FDA hasn't slowed down its

process of reviewing and approving new medicines. This leaves agencies

to forge ahead with their PR plans for pharmaceutical companies. In

fact, the FDA was holding a public review of 30-40 new drugs when the

first plane struck the World Trade Center. Instead of stopping, the

department continued the review, and has since approved four new drugs:

Foradil, Xeloda, NuvaRing, and Entocort.

Product launches that may have been postponed because of the attacks

have been rescheduled, and most agencies admit that the main challenge

facing them is to make sure that product pitches remain relevant in the

current climate. Most are tending to give conservative advice and


Some companies admit that individual tactical plans have been postponed

to make sure that the tone of their campaigns are sensitive to the

current feelings of fear and anxiety.

"This is a time when the mettle between the agency and the client will

be tested," says Nancy Turett, New York-based president of Edelman's

health practice. "Some individual plans have been postponed so that we

can refocus and work with the client to change the tone of the campaign,

and wrap it into a current message."

And while many agencies admit that a more conservative approach is the

stance of the moment, they believe that their PR plans haven't been

nearly as affected as those of the advertising industry.

Strange side effects

Ironically, the current climate may actually encourage the FDA to speed

up its efforts to approve new drugs. "Research is going to take on a

greater urgency," says Marina Maher, president of Marina Maher


"The challenge is being responsive to the shifting needs of the public,

and also working out long-term strategic plans in a climate where

uncertainty is the rule of the day."

Public panic and an understandable appetite for information following

the attacks of September 11 soon led to a river of rumors and

misinformation that flooded the media. Public health information groups

were thrust into the spotlight to stem the flow of hearsay.

The World Health Organization (WHO) responded to initial fears of

bioterrorism by producing a report entitled "Health Aspects of

Biological and Chemical Weapons," and inadvertently attracted the

largest amount of media attention in its history.

"Originally, we hadn't planned on talking to any media," says Jon Liden,

communications advisor to the director general. "We didn't want to drive

up the already high level of anxiety in the US."

But news that crop dusters had been grounded for two days throughout the

country led the organization to produce a press release drawing

attention to the fact that most countries are woefully unprepared for a


The WHO's 15-member communications staff found itself inundated with

calls about the report. And 40-50 advocacy members also took to the

phones to handle media calls from around the world. Liden, who usually

doesn't speak with the media, says that he had to pitch in, and gave

about 200 interviews in two days. "Our message has been simple:

Countries around the world have to build up preparedness for biological

warfare. As of now, most countries have no capacity to deal with such a

catastrophic event should it occur."

The central communications team of the WHO would play a part in any

biological attack on the US. Working with The Global Outbreak Alert and

Response Network, which is composed of 72 global and regional networks

that continually monitor reports and rumors of diseases around the

world, the team's job would be to send members to the outbreak site and

provide information to the Geneva headquarters.

"We would guide and advise governments on how to contain the spread of

the disease," says Liden. "Our job is not to provide panic, but to bring

clear and concise information to the public."

But while the WHO was busy fielding calls and trying to inform the

public about the threats of bioterrorism, Bioport, a beleaguered

Michigan pharmaceutical company, was trying to cope with the stress of

suddenly being forced into the forefront of anthrax fears.

Bioport is the only US company licensed to produce the anthrax


And with anthrax cases being reported in several states, the toxic

bacteria is the new threat causing fear for the public and the media


Kim Brennen Root, Bioport's spokesperson, says that the September 11

attacks have raised awareness of the "small Midwestern plant" that

counts the anthrax vaccine as its sole product. Although Bioport has

used a local PR agency before, Root says that she is currently handling

all of the company's media relations.

Root estimates that she has fielded at least 20 media inquiries a day

from such luminaries as The Wall Street Journal, the AP, CNN, and


However, most calls have come not from the media, but from a terrified

public that wants to find out how it can acquire the anthrax


Within three days of the attack, Bioport had received 1,000 calls from

frightened people. The company set up a consumer hotline (517-327-1656)

to inform the public that "all the anthrax vaccine stockpile that exists

is owned by the Department of Defense, and is for the protection of the

men and women who are risking their lives to fight for our freedom."

Bioport was hesitant to say if or when it might have the vaccine

available to civilians. However, the hotline message states that "we are

discussing the best way of meeting the needs of all who wish to receive

protection from the deadly anthrax bacteria." Root would only say that

Bioport was "fully committed to protecting life."

The trouble is, Bioport has been plagued by manufacturing problems, and

a long list of infractions led to the forced closure of its

manufacturing plant well over a year ago. While all of Bioport's energy

is now focused on having its plant reapproved by the FDA, the anthrax

vaccine is not expected to go back into production until at least


Mental health awareness

For many people, the shock of the initial attacks, coupled with the fear

and anxiety of future biowarfare, has been difficult to digest. One

particular concern has been post-traumatic stress. Often experienced

after people have survived a life-threatening situation, it manifests

itself through sleeplessness, flashbacks, and detachment from daily

life. Accordingly, mental health professionals have launched efforts to

inform the public about services that are available to them.

The New York City chapter of the National Mental Health Association

(NMHA) has developed a campaign with the city - called Lifenet - to make

New Yorkers aware of post-traumatic stress syndrome.

Bill Southard, president of Southard Communications, has been a member

of the NMHA's board of directors for two years, and his agency will help

design and launch the campaign pro bono. "We want to communicate to New

Yorkers that there are grief and mental health counseling services

available to them," he says. No budget for the initiative has been


The NMHA will target the campaign toward families, seniors, and children

affected by the tragedy, and it will create educational materials to be

handed out at schools and senior housing developments. The NMHA will

also write editorials for New York-based newspapers, and work with the

media on placing other stories in print and on television. There will

also be a subway advertising campaign offering tips on post-traumatic

stress symptoms, and a hotline (1-800-LIFENET) on which people can speak

to mental health professionals.

The educational campaign is a prototype that the rest of the country

will be able to use in case of another horrible emergency. "It will

hopefully make people aware of the services available to them, and

provide an anchor to the public," says Giselle Stolper, executive

director for the New York City chapter of the NMHA. "During this time of

crisis, we're acting as the city's primary public education voice."

Another mental health agency has rushed to produce public service

announcements to educate the public about depression and anxiety. The

National Mental Health Awareness Campaign (NMHAC) and the Ad Council

have created two PSAs that will be broadcast on national TV and radio

during the next six months.

The spokespeople and stars of the PSAs are Tipper Gore and Alma


Washington, DC agency Susan Davis International wrote the PSAs, and

coordinated the launch of the campaign. The group is also handling media

relations for the NMHAC.

"People are talking about the mental health issues related to the crisis

everywhere," says Jennifer Devlin, VP of media relations at Susan


"We want to communicate that it's okay to talk with mental health

experts if you feel you need to."

The PSAs offer a toll-free number (877-495-0009) and a website

(, linking people to mental health services in their


As the spokespeople, Gore and Powell have appeared on a number of

national and local morning TV programs, including Good Morning America

and the CBS' Early Show, and have cowritten an editorial featured in USA


Another aspect of the campaign will focus on creating forums to educate

journalists on how to write about and cover mental health. The group

will also release a poll that provides statistics on how the national

psyche is holding up since the attacks.

"The next step is a town hall meeting in New York with survivors of the

attack and firefighters," says Devlin. Tipper Gore will host the town

hall meeting, which will then be held in Washington, DC and at other

locations around the country.

Changing with public sentiment

Of course, the guiding force behind the kinds of campaigns that agencies

decide to run will be the public mood and how it has changed since the

attacks. Some agencies say that, at least temporarily, consumers may shy

away from so-called lifestyle drugs, such as Viagra or other medications

not considered to be life-saving. But as consumers adjust to new life in

the US, most agencies believe that the public will come back to

lifestyle drugs.

"I don't like the term 'lifestyle' drugs," says Edelman's Turett. "To

many people, those medications that combat obesity, balding, erectile

dysfunction, and other life-quality issues are the difference between

feeling confident about yourself and being unhappy."

Many agencies believe that healthcare will grow out of the tragedy,

because taking care of health is something that people can exert control

over. "We are starting to see a return to nesting and to family, things

that we can control," confirms Tom Beall, managing director of Ogilvy's

global health and medical practice.

The public mood, however, may prove decisive in shifting toward issues

that may not have enjoyed popular support previously, but will now be

accepted, such as the privacy arena. Consumers typically have grave

reservations about sharing their private information with a number of

hospitals and healthcare agencies. An issue that has come to prominence

since September 11 is the idea of a national data network, which would

provide an electrical medical record of every person in the US. In times

of a crisis, the ability to move information quickly is of paramount

importance. An agency specializing in healthcare technology PR would now

find a much easier and less decisive environment in which to pitch such

a network, and to draw a positive response.

"National defense has taken over as number-one right now," says John

Smith, SVP of the health practice at Brodeur. "Where people would have

previously put up more of a fight about privacy, there is an

understanding that such a system now makes sense."

However, as the healthcare PR industry and the rest of the world change

in the wake of the horrible attacks, it may come to the realization that

both public mood and the word "normal" have been permanently



Anthrax cases have provoked hysteria in an already-anxious public. And

Lansing, MI-based Bioport has been thrust into the spotlight as the only

company in the US licensed to produce the anthrax vaccine. In fact,

that's all it produces.

"There has been an evolution in how the news has been reporting the

terrorism," says sole spokesperson Kim Brennen Root. "At first, it

centered on what happened and what we do as a nation. Invariably, it

shifted to how it could have been worse. The first threat to come to

mind was bioterrorism. That's when we entered the story." In response to

numerous inquiries, Bioport set up a consumer hotline (517-327-1656) to

answer questions about vaccine availability.

Bioport is currently focusing on getting its plant reapproved by the FDA

after multiple infractions forced its closure over a year ago.

"Our commitment is to protect human life and meet the current demands of

the Department of Defense," says Root. "What happened has changed the

profile and focus of our company."

Root expects the company to start manufacturing again in mid-October,

which means that the anthrax vaccine won't go back into production until

at least 2002.

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