Sara Calabro looks at how question marks over drug advertising could open up avenues for PR.Finding themselves under constant scrutiny lately, pharmaceutical companies are faced with justifying high costs of direct-to-consumer (DTC) advertising, as well as the motive behind it. Critics claim ads for prescription drugs are part of a money-making scheme, rather than a method of informing patients. And not only is pharmaceutical DTC advertising self-serving, according to critics, it can also mislead patients by not thoroughly explaining all uses or side effects. The challenge for DTC proponents intensified in December of last year when the General Accounting Office, Congress' investigative arm, confirmed that several pharmaceutical companies had aired disingenuous ads promoting the same drugs for which they had already received citations. At the time, FDA head Mark McClellan responded by saying the agency would crack down on ads that made false or misleading claims. A December 12 New York Times article quoted McClellan as saying, "If we see patterns of recurrent use of misleading techniques in advertising, we will go further than warning letters. We will not be afraid to go to court." On the same day, the Times revealed the results of a report done by market analysis firm Datamonitor, which discussed promotional spending by drug companies over the past four years. The article reported that in 2001, the top drug companies generated $17 in sales from every dollar spent on marketing. That was down from $22.20 for each dollar spent in 1998. Datamonitor concluded, "To continue to finance the large increases in promotional expenses, some companies will be forced to decrease spending in areas like research aimed at finding new drugs." Most PR people agree that DTC advertising has become an integral part of pharmaceutical marketing - one that is not going to disappear anytime soon. But as public criticism, FDA crackdowns, and revelatory studies about the controversial tactic loom, in addition to the prevalent problem of economy-wide budget cuts, PR has become an increasingly important element of the marketing mix. For better or worse, as its DTC counterpart repeatedly finds itself in the limelight, PR's value continues to be more widely recognized. Educating consumers Michael Rinaldo, SVP and senior partner in Fleishman-Hillard's healthcare practice, feels that the recent eminence of DTC advertising - for better or worse - has resulted in an increased need for effective PR that runs in a parallel fashion. DTC ads speak to all audiences with the same message, while PR creates an opportunity to follow up with tailored messages. "A senior who's been diagnosed with cancer is going to be interested in a simple, substance-based treatment, but younger patients want to understand their conditions on a more in-depth level," claims Rinaldo. Peppers & Rogers, a managing consulting firm, agrees that DTC advertising is not an effective tool on its own because it is based on treating all customers the same. According to Kathryn Kavicky, director of PR and communications for the firm, DTC advertising "is only a temporary panacea for the industry because there is little or no chance for current sales results to translate into loyal customers." Without direct interaction with customers, she contends, pharmaceutical companies cannot build the relationships necessary for repeat purchases, long-term revenue growth, and loyal customers. Peppers & Rogers principal Marc Ruggiano recommends pharmaceutical companies build awareness through DTC, and then cultivate specific actions through targeted PR messages. He asserts that these lessons can be learned by looking at other industries' experiences with DTC. While it's important to recognize that putting together information about health is different than dealing with, say, cars, Ruggiano reminds, "There is no reason the pharmaceutical industry has to learn everything from scratch. Other industries have been using DTC for years, before drug companies caught on." DTC advertising should be planned as part of an overall promotional set of marketing activities. "The real power is in combination," says Ruggiano. "Unless you are dealing with a blockbuster drug, DTC on its own is suboptimal because it essentially stimulates the market for other products in that category. Ads need to be complemented with PR so that people can seek more information when faced with a choice." Tom Jones, executive director of communications for Novartis, agrees. "At the end of the day, we have to sell drugs," he says. "In order to do that, the two disciplines need to be integrated and complementary." Novartis' approach to promoting products reflects this philosophy. For its irritable bowel syndrome (IBS) drug Zelnorm, the company has decided not to do any DTC advertising until it is confident the public understands the disorder. "Zelnorm is in a category that people are afraid to talk about," says Jones. "We have turned to PR to help the public understand that IBS is a medical disorder and not a psychosomatic condition, which is what the media has previously played it out to be." Zelnorm's PR team has begun by talking about the symptoms of IBS in a way it believes consumers will find tangible. It is communicating the "ABC's," which stands for abdominal pain, bloating, and constipation. Testing before turning to DTC Similarly, Novartis has not begun a DTC advertising campaign for its recently launched eczema drug, Elidel. Because the treatment is steroid-based, Novartis wants to make sure consumers understand what the medication does, without confusing it with other commonly held associations with steroids. Jones says Novartis will test public perceptions before launching DTC for Elidel. "If we find people are not receptive to the education awareness, we won't launch the ads yet." Rather than one taking precedent over another in critically and economically trying times for drug companies, PR and DTC advertising feed off one another. Steve Lampert, senior director of public affairs for AstraZeneca, reports that his company has not cut back on the money spent on DTC advertising because it has been effective in bringing undiagnosed patients closer to treatment. However, he acknowledges that current issues facing the industry have changed the way PR is viewed. "We've had more of an opportunity to demonstrate our value because more calls are coming in, particularly having to do with pricing." Michael Durand, partner and director of global healthcare for Porter Novelli, agrees that an environment in which advertising flourishes creates opportunity for PR. "Just because you buy life insurance, it doesn't mean you're going to cut down on your auto insurance," he says. "As DTC advertising becomes more widely used, expenditures on PR continue to rise as well." PR that follows DTC advertising is equally important to that which precedes or runs simultaneously. In 2002, Porter Novelli conducted a survey asking consumers who they trust when looking for health information. Seventy-seven percent said they trust their doctors, and 63% reported trusting their pharmacists. Only 17% said they believed what they saw on TV. This indicates that although DTC advertising reaches a large number of people (a survey by the National Consumer League in January reported that 77% of adults have seen or heard advertising for prescription drugs in the past 12 months, including 22% who have seen one about a medication treating a condition of particular interest to them), consumers are often left with questions. Largely because of the internet, patients are more educated about their own healthcare than ever before. But even the most informed consumers still need to visit their doctors in order to get prescriptions written, and any remaining questions about a drug are best answered by this most trusted source. So although the broader role of pharmaceutical PR lies in the consumer area, outreach to physicians - predominantly through salespeople, which are still doctors' most frequent point of contact at a drug company - is done as well to help complete the final step in accessing prescription medications.