Complementary and alternative medicine (CAM) is one of the fastest growing health sectors in the UK.
Researcher Mintel valued the market at £147m in 2004, a 44 per cent increase on 1999's valuation – and this growth is not expected to slow. But it is an industry crying out for PR expertise.
Amid the strong consumer demand for CAM – the prime buyers are middle-aged, AB women seeking more natural healthcare treatments – there is also widespread confusion, lack of knowledge, and doubt about the efficacy and safety of the products.
Fear of the unknown
In Mintel's survey, 29 per cent of consumers said insufficient knowledge of CAM was a main reason for not trying products, while 11 per cent were worried about the possible side effects. Nineteen per cent said they would only trust clinically proven medicines.
Lack of knowledge of CAM is not confined to consumers. GPs, who have not been given official guidelines on herbal and other alternative therapies, are under increasing patient pressure to prescribe – or at least recommend – them. And pharmacies are under similar pressure to supply the products.
The CAM market is one ripe for PR exploitation, with multiple audiences seeking different information. So, how is this challenge being met?
1. PR TO CONSUMERS
With such a ripe opportunity to change consumer opinion, surely many PR agencies are salivating at the prospect of getting their hands on a CAM account? Well, not all of them.
Liz Shanahan, MD of Santé Communications, whose clients include Roche, GlaxoSmithKline, GE Healthcare and Procter & Gamble Pharmaceuticals says: 'There is no evidence to convince me that many of these products really work. Until I see that, it is not an area I will go near. I don't think it is ethical to give people false hopes.' She cites homeopathy and Chinese medicine as areas the agency would particularly avoid.
Unsurprisingly, there are plenty of counter-opinions. Jerome Burne, who contributes CAM articles to The Times and is researching a book about drug alternatives, says it is a subject in which Times readers are interested.
'Drugs companies take the line that "our stuff is tested and anything alternative is rubbish",' he claims. He adds that bullyboy tactics, such as threatening to pull ad spend from magazines deemed critical of Big Pharma, prevent an open debate on the relative merits of CAM and pharma firms' established products.
But the PR budgets of pharmaceuticals dwarf those of firms operating in the alternative health sector – a market teeming with small manufacturers. It is often the case that only the bigger CAM brands can afford to hire PR agencies.
Homeopathy brand Nelsons retains GCI Healthcare for comms (see box). GCI account director Andrew Stevens argues CAM cannot be dismissed for its inability to satisfy research methods designed for orthodox medicine. He says the PR industry must recognise the rise of CAM, especially as publications want to devote more space to it.
'To write off CAM when there are 12 million users in the UK is rather
narrow minded,' he says. 'Our job is to make sure people are aware of CAM and where they can get it.'
Understand your medicine
PROs must tread carefully and avoid overstating the benefits of products. Phrases such as 'miracle cure' are particularly frowned upon by the sceptical, while many practitioners prefer the term 'complementary' to 'alternative'.
Tracey Hollom, associate director of Pegasus Public Relations, which promotes food supplements and herbal medicine, says: 'We place great importance on supplying journalists with clinical research data, as well as access to experts, customer testimonials and first-hand experience. It takes a long time to explain the benefits to journalists; that is why we prefer one-to-one briefings.'
But journalist Sarah Ewing, who writes for Natural Health & Well-being, Essentials and Healthy, says PROs who know this field well are rare.
'Many PROs who approach me know little about healthcare and less about complementary medicine,' she says. 'There is a minority that takes understanding of the products seriously, and I'm more inclined to feature these PROs' products.'
2. PR TO GPs AND PHARMACIES, AND THE ROLE OF THE NHS
Persuading healthcare professionals of the benefits of complementary medicine is crucial in the promotion of alternatives to consumers. According to Mintel, over a third of people (37 per cent) would like doctors and pharmacists to recommend more use of alternative medicine. A study by Sheffield University, meanwhile, shows that almost half of all GPs in England already give their patients access to some form of complementary therapy.
The extent to which CAM is prescribed and sold varies from doctor to doctor and pharmacist to pharmacist, and largely depends on healthcare workers' personal predisposition to alternative medicine – something that astute PR could influence.
Nevertheless, no clear guidance has yet been issued to the medical profession from either government or the major trade bodies, such as the British Medical Association (BMA) and the General Medical Council (GMC).
'A more coherent, considered approach to communications is needed,' says Kim Lavely, chief executive of The Prince of Wales's Foundation for Integrated Health. 'We want the National Institute for Health and Clinical Excellence (NICE) and the Department of Health to take a clearer line.'
But she adds: 'There are signs of this happening. A white paper, for
example, is being published this month on taking a more integrated approach to CAM.'
Janet Groves, chairman of natural remedy maker GR Lane Health Products, believes the best way to ensure consistent messaging is to integrate the study of CAM into the training of medical professionals.
But it is difficult to gauge the importance of PR in educating the industry: neither the NHS, GMC nor BMA press offices could provide any information on the extent to which healthcare professionals are targeted with CAM-related PR material.
Most PROs are focusing their efforts on consumers – hoping that public demand will effectively force the medical profession to take note. But targeting healthcare professionals is not totally overlooked. MRA PR account director Mark Smith, who works on vitamin and herbal supplement maker Health Aid, says trade titles such as Chemist & Druggist are important channels. 'It is necessary to target these titles because their readers are selling our products.
Pharmacists want to find out what products are available, so we tend to be as factual as possible.'
The NHS has been slow to embrace CAM at a national level. But after overwhelming consumer interest, government has been forced to recognise the role of alternative medicine alongside conventional drugs (see box).
As well as supplying consumers with more information on complementary therapies, and developing national guidelines for practitioners, the DoH is also tackling the thorny issue of research. 'It is important that, as more people turn to these therapies, a solid evidence base for CAM is developed,' says Jonathan Carroll, DoH media officer for quality, public health and care services. 'That is why we have provided nearly £3m to develop CAM researchers.'
Another important development is the EU Directive on Traditional Medicinal Use, which became UK law in October. As part of this legislation, over-the-counter herbal medicine must meet specific safety and quality standards. There are also moves afoot to further regulate acupuncture and herbal medicine by developing legally binding standards for training and practice. Osteopathy and chiropractic care are also regulated, and other strands of complementary health are likely to follow suit.
All this should pave the way to greater uptake of CAM within the NHS, and improve its credibility in the eyes of the medical profession.
3. THE IMAGE OF CAM
Groups representing CAM are well aware that their industry has a serious image problem and that they need to use PR more effectively. Some, such as the British Complementary Medicine Association, are introducing PR budgets into their strategies for the first time next year. But the fact that there are so many
associations vying for attention, often with different messages, is not helping to raise credibility. BMA head of media relations Linda Millington says: 'There is often a plethora of associations within a therapy, but in many instances neither patients nor health professionals are confident in the efficacy and safety of their procedures.'
The Faculty of Homeopathy chairman Sally Penrose is currently reviewing its PR strategy. She says she would like to be more proactive in terms of consumer and regional press relations.
The faculty's main campaigning issues mirror those of other bodies in the sector: to increase the availability of treatment via the NHS, to position homeopathy as a therapy that works, and to influence debate about how to measure the effectiveness of CAM.
Penrose, who has an in-house communications officer and uses a
PR consultant for project work, says: 'Homeopathy attracts polarised, often hostile comments in the press, and we are constantly seeking to correct inaccurate statements and misunderstandings. While homeopathy attracts a lot of media attention, we don't have the funds available to outsource PR to a large agency.'
This is a common complaint. The Register of Chinese Herbal Medicine, for example, enlisted the help of Furner Communications this year following a spate of bad press, but this was only on a temporary basis (see box).
An association that does retain an agency is the British Acupuncture Council (BAcC), which has worked with agency Republic for over three years. Republic's focus has been on consumer press, providing case studies of where acupuncture has worked particularly effectively. 'It has always been a challenge to communicate the benefits of acupuncture: fear of the unknown and the odd false horror story along the way have meant that consumers and media are sceptical,' says account manager Jo Wilmot.
Celebrities have been a godsend in securing high-profile, positive coverage. Gwyneth Paltrow's use of acupuncture in particular has enabled Republic to generate significant editorial space in the glossies. Last year Paltrow attended a New York film premiere in a backless dress that exposed circular marks on her flesh: the result of acupuncture treatment known as cupping. Wilmot says: 'It was being positioned as a cranky celebrity treatment, so we used the
story to challenge that preconception and explain to people that it is a medical treatment that consumers can't just have on demand. We also used it to stress the importance of seeing a registered practitioner.'
The Paltrow story gave BAcC a mention in broadcast media such as BBC Breakfast, as well as widespread print coverage. A press release explained the cupping treatment and offered journalists the chance to try it for themselves. 'The coverage was phenomenal. Initially it had been quite negative, but in the end it was positive,' says Wilmot.
Republic now has its sights on the largely untapped male and older
consumer market. Last year it ran a campaign about sports injuries, in which the England rugby team's acupuncturist discussed the benefits of the therapy. Media were invited to witness players being treated, resulting in coverage in papers such as the Daily Express, as well as sports titles including Rugby World. 'There's still a lot of work to be done in getting men more interested in health and thinking about alternatives,' adds Wilmot.
Homeopathy, meanwhile, has also benefited from endorsements, including those of Sir Paul McCartney and Victoria and David Beckham.
Good Relations account director Julia Farish found the media similarly receptive to CAM during a three-month project for The Shiatsu Society (shiatsu is similar to chiropractice). The brief was to raise awareness of this year's European Shiatsu Week, particularly among 18 to 45-year-old women.
The agency linked up with GMTV's Dr Hilary Jones who conducted a
series of radio interviews. Farish organised press launches, sourced case studies and invited journalists to experience shiatsu. 'We wanted to talk to journalists directly and get them to try it out,' she says. 'A lot of them didn't even know that it's a treatment one has while fully clothed and does not include anything that might make you feel uncomfortable.'
Coverage was achieved on radio station BBC Wales and in London's Evening Standard, The Times and Good Housekeeping magazine.
On the back of the success of this campaign, The Shiatsu Society has appointed Good Relations to work on another three-month project to highlight the benefits of the treatment.
The Foundation for Integrated Health's Lavely says such case studies prove that PR has a central role to play in CAM, in terms of targeting consumers and influencing policy makers.
'There's a tremendous role for PR,' she says. 'It can help encourage the move to a stronger regulatory framework and get the message across that an integrated approach is a mainstream one, not flaky or fringe-like. There's still a lot to do, but we certainly expect to have a lot more influence in future.'
Case study: bach flower remedies
GCI Healthcare, which works with conventional and complementary medicine brands, believes PR has an important educational role to play in the CAM market. According to account director Andrew Stevens, the challenge is reaching non-health-aware audiences.
Getting coverage in national media can be difficult without hard clinical data. As a result, Stevens devotes much time to media relations. The message is that complementary medicine should
not be judged via the same framework used for conventional treatments, because results vary depending on the patient.
GCI handles consumer and corporate PR for Nelsons, the UK's largest manufacturer of natural medicines, with a large portfolio of homeopathic treatments. Its focus is on homeopathy, with a brief to position the company as an expert in the field. One of its brands, Bach Flower Remedies, has benefited from celebrity endorsement from users such as Jennifer Aniston, Liz Hurley and rock band Kaiser Chiefs.
However, Nelsons wanted to run a campaign that promoted it as an everyday product to combat stress, rather than an exclusive celebrity treatment. 'We had to do something to bring the brand down to a level that everyone could relate to. The problem was that the topic of stress has been done to death so we had to find an exciting angle on it,' says Stevens.
GCI commissioned a survey that quizzed 3,000 Londoners about their attitude to stress, finding that one in five were too busy at work to take a proper lunch break. In June, the agency set up an event in London's Soho Square (pictured) that called on workers to relax. Called 'Rescue your missing lunch hour', it gave the public the opportunity to take advantage of stress-relieving techniques such as Indian head massages and Tai Chi. Bananas were handed out to provide sustenance, and a Nelsons consultant was on site for advice.
Stevens says: 'The purpose was not so much to generate coverage but to give a positive experience.'
Government Wakes Up to Consumer demand
* The DoH has committed three years' funding to the Foundation for Integrated Health (FIH) to develop regulatory guidelines for certain alternative practitioners.
* FIH commissioned economist Christopher Smallwood to study the role of CAM in the NHS. He concluded there should be more complementary therapies available and called for NICE to further investigate the gap in provision.
* FIH recently published 'Complementary Healthcare: A Guide for Patients' on behalf of the DoH, explaining the potential benefits of alternative therapies.
* The DoH has provided nearly £3m to develop CAM researchers.
* The DoH has also provided £324,000 for three qualitative research projects on CAM in the care of patients with cancer.
* The Medicines and Healthcare products Regulatory Agency
has set up a Herbal Medicines Advisory Committee, which analyses safety and provides practitioners with information about results.
Alternative trade bodies and their PR
Name: The Register of Chinese Herbal Medicine
Number of members: 200 (acupuncturists and herbalists)
Main issues: Campaigned on Herb safety and efficacy; the need to consult practitioners listed on the register PR status Furner Communications on a project basis
Name: National Institute of Medical Herbalists
Number of members: 725 (registered herbalists)
Main issues: campaigned on The need for better labelling of products, better research and greater access to information; the need to consult a registered practitioner; raising awareness of the therapy; Herbal Medicine Awareness Week
PR status Handled in-house and via an independent PR consultant
Name: The British Acupuncture Council
Number of mmbers: 2,600 (professional acupuncturists who have a minimum of five years' training)
Main issues: campaigned on The need to consult council-registered practitioners; dispelling misperceptions that acupuncture is only about pain management and needles; positioning the council as a leading voice in the field PR status Retains Republic and has a part-time in-house PR manager
Name: The Shiatsu Society
Number of members: 2,000 (a third are registered practitioners, others include students and teachers)
Main issues: campaigned on Encouraging consumers to consider shiatsu instead of conventional medicine for conditions such as stress and back ache; raising awareness of shiatsu and the society's role and events PR status Hired Good Relations in July