It has been a year in which the cost of medicines has seldom been
far from the headlines. Although Viagra has produced the most column
inches, reimbursement (that is, when drugs can be prescribed on the NHS)
is not a one-product issue.
In October, for instance, the Association of the British Pharmaceutical
Industry (ABPI) director-general Dr Trevor Jones warned the Government
that it risked losing investment in UK medicine production because too
much emphasis was being placed on the cost of ethical pharmaceuticals
rather than their value. His comments came in the wake of a
PricewaterhouseCoopers report which pointed to 7,000 job losses in the
UK pharmaceutical manufacturing industry.
One area of concern highlighted by the report was the future of the
Pharmaceutical Price Regulation Scheme (PPRS) which imposes a ceiling on
pharmaceutical companies’ profits on sales to the NHS. Another source of
worry to the ABPI is so-called ’postcode prescribing’, where someone on
one side of a street may not receive a treatment given to a neighbour
because they live in different health authority areas.
When Health Secretary Frank Dobson announced that the anti-impotence
pill Viagra was to be temporarily banned from the NHS a day before its
UK launch both its manufacturer Pfizer and the ABPI expressed dismay at
the decision. The economics of healthcare provision were seen to be at
the heart of the Government’s NHS reforms. The implicit message seemed
to be that the granting of a pharmaceutical product licence was no
longer a guarantee that the product could be prescribed on the NHS.
’The Viagra affair sets, I think, a precedent for other medicines which
is not good for the NHS or patients,’ says ABPI head of media relations
Richard Ley. ’The thing we should emphasise is that prescription
medicines are the only form of NHS treatment to need a licence. To get
one they have to prove that they are safe and that they work.’
But in the present climate cost is almost as much of a factor as safety
and effectiveness. Although the Government is loath to use the word
rationing, it appears increasingly to be a fact of life.
Pfizer public affairs director Miranda Kavanagh thinks that there needs
to be greater clarity on the situation. If there are indeed finite
resources allocated to prescribing medicines it would be ’honest’ to
concede so in public, she argues.
’The first thing is to have a debate about the issue and from there you
can move on towards a solution,’ says Kavanagh. ’But I think private
prescribing is going to become more a fact of life.’
Pfizer and the ABPI, both directly and through GJW, has been lobbying
the Government for a change of heart. At the time of writing, however,
it seems that while Viagra will be allowed on prescription its use will
be strictly controlled.
Availability of the pounds 4.84-a-time pill will be limited to patients
suffering from physical, rather than psychological forms of impotence.
The Government clearly does not wish to swell a drugs budget, currently
estimated at about pounds 6.3 billion, with what have come to be known
as ’lifestyle’ medicines.
Its determination to keep costs in check can be illustrated by its drive
to curb the prescription of antibiotics where their use may be of
questionable therapeutic value.
All of this is happening at a time of transition. Shire Hall
Communications director of NHS Services Anita Baylis goes so far as to
call the current change agenda for the health service ’vast and
extremely rapid’. Next year will see the introduction of new bodies and
new systems that will have a profound impact on the NHS.
For a start, we will see the advent of Primary Care Groups (PCGs) each
of which will plan, purchase and provide healthcare for around 100,000
people. Each PCG board will include GPs, a community nurse and a
representative from social services.
In April there will be the birth of the National Institute of Clinical
Excellence (NICE), a centralised body that will develop guidelines on
the clinical benefits and cost-effectiveness of treatments. Alongside
this there will be the rolling out of PRODIGY, a computerised
prescribing advice system for GPs said to be the first national system
of its kind in the world.
The system will give doctors up-to-date advice from NICE which they can
discuss with patients while it is on screen. It will also contain
patient information leaflets on many conditions, which can be printed
out on the spot.
’NICE will hold the keys to the gates of the NHS markets,’ says Charles
Barker BSMG director of healthcare Rachel Dalton. ’It will judge
benefits, including the cost-effectiveness of all new medical products.
An unsatisfactory assessment by NICE is akin to a death sentence for a
product within the NHS.’
The appointment of Professor Michael Rawlins as chairman-designate of
NICE sends out a further signal as to the strong focus it will have on
drugs policy. Rawlins is a world renowned expert in the clinical
pharmacology field and is currently chairman of the Committee on Safety
of Medicines.
The creation of PCGs will also have major implications. Although the
exact impact PCGs will have on prescribing are still uncertain, one of
their aims will be to keep a tight grip on budgets by prescribing
generic, rather than branded drugs. Brand development will therefore
become even more of a vital issue for pharmaceutical companies looking
to make a reasonable return on their investment in research and
development.
The imperative to keep down costs may cause problems. Baylis gives the
example of one GP who recently took part in a focus group. He said he
could see that a certain treatment would save costs further down the
line because of its preventative benefits but was flummoxed as to how he
might find the extra budget to cover it in the short term.
Clearly understanding the new decision-making processes and identifying
and targeting the key decision makers following the restructuring will
be of utmost importance.
Mark Chataway, a founder of Interscience, predicts turbulent times ahead
for both agencies and drugs companies as the traditional role of
targeting prescribers will diminish and patients become the target
audience.
’In an age of patient activism it will be a steep learning curve and
consultancies can learn a few tricks from other PR sectors in a bid to
attract consumers’ disposable income. ’But,’ he warns, ’agencies must be
aware of legality when marketing drugs. However this will create great
opportunities too as, previously, agencies’ only recourse has been to
doctors and administrators. In the future we will talk directly to
patients and their families.’
However, with drugs budgets seemingly more circumscribed than ever, it
is the ’lifestyle’ products that stand the greater likelihood of missing
out. The prescription of drugs for chronic or life-threatening
conditions will of course be given precedence.
This means manufacturers of lifestyle drugs will have to use
communications very effectively if they are to succeed in seeing their
products widely prescribed. Aside from Viagra, drugs launched this
autumn that may arguably be classed in the lifestyle bracket include
Roche’s anti-obesity treatment Xenical, Smith-Kline Beecham’s social
phobia medicine Seroxat and Eli Lilly’s HRT product for post-menopausal
women, Evista.
Cohn and Wolfe director Angie Searle says: ’It’s going to be an
increasing challenge to get across the key benefits of a product without
it being trivialised. And if patients and GPs are to connect in any way
they need to have a similar understanding of a product.’ This, of
course, ties in with growing patient empowerment.
These days fewer and fewer ethical campaigns are constructed without the
inclusion of a patients’ group strategy. Consumer pressure for a drug
can be hard to resist. That much is a constant in a fast-changing
healthcare landscape.
BREAST IMPLANTS: Balancing vanity against necessity
Twice during the early-1990s, the Conservative Government conducted a
review into the safety of silicone breast implants. At the beginning of
this year the Labour Government, too, came under pressure to examine the
issue, in particular from anti-implant groups such as Silicone Support
and Survivors of Silicone.
Stories linking breast implants with silicone poisoning began appearing
in the national press and health minister Baroness Jay succumbed to
these concerns, announcing a third review of the matter. Inner Medical,
the market leader with its McGhan Breast Implants product, brought on
board Grayling and its public affairs arm, Westminster Strategy, to
defend the safety of modern implants and help prevent a moratorium on
their use.
One of the key tenets of the campaign was to remind journalists and
politicians that breast implants were used for medical purposes, not
just cosmetic ones. To lend credibility to the argument, experts in the
field were made available to the media.
Adam Searle, a consultant at Charing Cross Hospital explained how the
latest type of silicone gel is used to rebuild a breast. He provided a
case study of a patient who was 32 when she had a radical
mastectomy.
Following plastic surgery involving implantation, she is again able to
wear fashionable clothes and a bikini on holiday, thereby providing a
tremendous fillip to her self-confidence. Her story appeared in the
Daily Mail and the Times.
The campaign also called for women to be given the right to prompt
breast reconstruction on the NHS. There is a degree of inequality in
waiting times within different health authorities and the campaign made
the point that in some areas patients had waited for as long as ten
years for reconstructive surgery.
’One of the things we wanted to do was sensitise the public to the fact
that breast implants weren’t all about Baywatch,’ says Grayling managing
director, healthcare Peter Holden. ’There’s a very serious side to it in
terms of breast reconstruction after mastectomy. If a moratorium against
breast implants had come about then many women would have been seriously
disadvantaged.’
As it turned out, there is to be no moratorium. The Government review
concluded that silicone was safe and that information on the different
types of implant should be freely available to women.
’Grayling concentrated on all the good things about implants and made it
clear that while they may not have been as good 20 or 30 years ago,
technology moves on,’ says Inner Medical managing director Peter
Cranstone.
’At the end of the day science won out. The review is a fair reflection
of the scientific picture. What the PR did was redress the balance
against the negative articles there had been.’
SENSITIVE SUBJECTS: The trick of targeting taboo topics
Sandpiper Communications works on a cross-section of accounts covering
potentially ’taboo’ subjects - ranging from thrush to teenage pregnancy
- have called for a form of ’media diplomacy’ that mixes candour with
caution.
’Working in ’below the waist’ healthcare sectors means you can’t spare
the blushes if you want to get the message across,’ says Sandpiper
managing director Pippa Sands. ’Our role is predominantly to normalise
the issue and that means bringing it out into the open and using all
possible access points to talk about the issues, real and perceived.’
For Bayer’s range of Canesten anti-fungal treatments, Sandpiper has
worked to remove some of the embarrassment about thrush. Although almost
75 per cent of women suffer from thrush at some point in their lives,
many do not find it easy to talk about the condition.
Sandpiper’s campaign has focused on telling women that thrush is
normal.
This year’s Cosmo Show was used to give the condition a high profile to
over 50,000 young women. A web site was launched as was a thrush
telephone advice service.
Even more sensitive as an area for communications is teenage
pregnancies.
However, on behalf of client Clearblue, a home pregnancy test, Sandpiper
has targeted teens, particularly those at college or university.
’Any communication on the subject of teens and sex has got to be
approached with a degree of caution, a high level of judgement but most
importantly in an environment and language that works for them,’ says
Sands.
The campaign’s objective was to take the stigma out of talking about
unplanned pregnancies in order that young women would know as early as
possible whether or not they were pregnant. Using a ’real life’ angle,
Clearblue advertorials were placed in the teen press. In addition, there
were surveys and sponsorships in student guides. In total, the campaign
achieved a reach of nearly one million young people, without courting
controversy.
Clearly ’taboo’ subjects are not just restricted to women. There is
still a degree of ignorance among men about prostate and testicular
cancers, some of which can be ascribed to a reluctance to discuss ’below
the waist’ problems. With this year’s European Week Against Cancer
concentrating on male cancers, Sandpiper held a photocall at the Labour
Party Conference with ex-footballer Trevor Brooking - chosen as someone
men could identify with, thereby making these diseases appear less
alien.
Seven TV items were generated together with extensive coverage in the
regional press.
Adds Sands: ’Unless sensitive health issues are thrust into the public
arena, the barriers will remain in place. But we must always recognise
the responsibility of the role and the fine balance between acting as
guardians of a solution rather than creators of a sensation.’
STREPSILS: fighting off the common cold with zinc
The common cold is the enemy of productivity. According to US figures,
over 15 million working days per annum are lost to absenteeism due to
colds, at a cost to employers of USdollars 5 billion.
Zinc supplements, it has been found, help the body’s natural immune
system fight against infections such as colds. As a result, zinc
preparations have become popular in the US as part of a trend towards
infection prevention much better all around for consumers and employers
than treating an infection once it has occurred.
In a bid to galvanise consumers into taking action to keep the common
cold at bay Crookes Healthcare brand Strepsils launched Zinc Defence
earlier this year, the first zinc gluconate lozenge to hit the UK
market. Hill and Knowlton handled its PR, with a brief to convey the
benefits of zinc and create awareness of Zinc Defence.
Zinc Defence was launched to the trade media using briefings and generic
information on zinc was placed in the consumer media. A third party
expert - Professor Ron Eccles, director of the Common Cold Centre in
Cardiff featured heavily in the media relations campaign.
Consumers were targeted through health and lifestyle programmes on
regional radio stations and case studies were provided to media outlets
to introduce a human interest angle by highlighting people who already
use zinc. The case studies were of a working mother and a fitness
instructor.
Finally, a Zinc Defence Information Service was established on a
freephone number as a source of fact and comment on the common cold for
consumers, pharmacists, retailers and the media. This played a part in
the media relations campaign but is also being used as a sales promotion
tool - contact details have been included in material sent to
pharmacies.
Among the PR campaign results was a Daily Mail feature that included
case studies. There was also coverage in the Times and other consumer
print media. Interviews with Professor Eccles were broadcast on 21 local
radio stations and 12 articles appeared in the specialist pharmacy and
grocery media.
’Ron Eccles is famous within his field and highly regarded,’ says
Strepsils brand manager Emily Homer. ’To get his buy-in to our product
was very important. He gave a credibility and integrity which worked
well alongside the strength of the Strepsils brand. We’re very pleased
with the amount of trade and consumer coverage we got - and it’s still
coming in.’ Sales of the product, adds Homer, have exceeded the launch
target.
