FOCUS: HEALTHCARE PR - ’Lifestyle’ drugs seek a PR remedy. The Viagra debate has clearly shown why non-NHS medicines need good PR if they are to compete with prescribed brands. Robert Gray reports

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.

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.



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