INITIATING DIALOGUE: Healthcare professionals and pharmaceutical
companies can benefit from advisory boards
BREAKTHROUGHS: Communications makes its mark in education, clinical
trials, and debate in the NHS
TRADING PLACES: How the larger agencies have snapped up smaller
specialists to get into the healthcare sector
PR plays a unique role in bringing together the views of patients,
pharmaceutical companies and the medical profession. Hilary Freeman
reports
The pharmaceutical industry presents PR agencies with a unique
challenge. They must target their campaigns and marketing initiatives
not at the customer who will use the drugs, but at the prescriber. This
odd commercial situation has created a tripartite relationship - between
the healthcare PR agencies, their pharmaceutical clients and the
healthcare professionals working in relevant therapy areas.
Healthcare PR agencies have developed a number of tactics to deal with
the dynamics of this unusual relationship. With specialisation in
particular therapy areas now the norm, education has become the key.
Agencies aim to attract opinion leaders in the medical establishment who
will both impart their knowledge to clients and are open to new ideas
and developments in their field. Over the last ten years, many agencies
have begun to use advisory boards, teams of experts who are often culled
from the agency’s contact list.
Specialist healthcare PR company, Interaction has set up advisory boards
across its account base which includes Wyeth Laboratories. Comprised of
eight to ten health specialists, each board meets at regular intervals
to discuss individual therapy areas, to examine new clinical papers and
to provide direction for product development and marketing initiatives.
The Tunbridge Wells-based company also uses its advisory experts to help
write newsletters, which are sent to GPs, and articles for the medical
trade press.
Marian Byrt, account consultant at Interaction says advisory boards help
the relationship between the manufacturer and the medical professionals,
with the PR company acting as an intermediary: ‘The client gets the
educational benefit of expert opinion and approval for new products and
the members of the board get the chance to get together with their peers
to discuss patient issues. Our advisory boards have now become almost
autonomous,’ she says.
Byrt believes advisory boards are provide a more effective marketing
medium than the promotion of products in isolation. ‘The meetings guide
our promotional work, leading to actions which are more appropriate to
the market place. It’s a formula which works well.’
Martin Ellis, director of Cohn and Wolfe’s healthcare division says his
company uses a variety of different formats for advisory board meetings.
In the pre-marketing launch phase of the drug, an advisory board will be
used to confirm the positioning of a product in the marketplace and to
advise clinical research. In the post-marketing phase, an expert panel
can keep an on-going check on marketing activity and help the
pharmaceutical company increase awareness of particular conditions by,
for example, endorsing particular disease weeks, such as the recent
National Osteopathy Week.
Ellis says using medical experts gives drug companies public
credibility. ‘The public will not believe a company spokesman, but they
do believe an independent third party expert.’ But he warns that it may
not be wise to rely on medical professionals: ‘Any agency needs to be
acutely aware of the time constraints and pressures on opinion leaders.
You should not make unreasonable requests. Planning is the key.’
The use of advisory boards is condoned by the Association of the British
Pharmaceutical Industry. Richard Ley, the assocation’s head of media
relations, says that they give drug companies a better understanding of
the needs of customers: ‘The more that is done to maintain dialogue - or
in this case, trialogue - the better,’ he says. ‘Issues such as cost can
be raised and discussed in a useful environment.’
PR companies have also become involved in drug-company sponsored post-
graduate education authority seminars for GPs, often using their
advisory board panels as speakers. Such seminars enable the consultancy
or in-house department to run a product-oriented healthcare campaign,
while the GP gains points for continued approved training. Cohn and
Wolfe, for one, has produced a document on how to gain PGEA
accreditation and provides speakers and materials for seminars and
disease awareness groups at both a local and national level. It sends
out mail-shots to GPs, hoping to attract those with a specific interest
in the disease area -potential new opinion leaders - rather than those
who just wish to tot up more points. Some agencies offer drug company
sponsored training courses, teaching doctors presentation, business and
editorial skills.
The Royal College of General Practitioners has strict guidelines on
sponsorship, preferring to offer its own seminars where possible.
Although sponsorship means it does not have to charge delegate fees, it
is wary of associating its name with particular pharmaceutical
companies. This cautious attitude is prevalent across the medical
establishment. Many doctors feel that they are already overloaded with
advertisements and mailings from drug companies and are unable to
distinguish between carefully marketed literature and what they perceive
to be ‘junk mail’.
Dr Joe Collier, clinical pharmacologist at St George’s Hospital Medical
School, has published papers on the relationship between the drug
industry and the medical profession.
He says PR initiatives may not be beneficial in this respect: ‘Doctors
are wary of the advice given by drug companies and they are wary of PR
people. Focus groups have been going on for years - I don’t think they
make any difference. They just muddy the waters. The closer a doctor
gets to the industry, the more difficult it is to be independent.’
Dr Collier concedes that the relationship has improved in recent years:
‘Historically, drug companies have led doctors by the nose. But, as
doctors have become more questioning, the industry has begun to put the
relationship to rights. However, it is in many respects at an impasse.
Doctors and drug companies are going down two separate tracks - it is
difficult to see how they can work together.’
Dr Peter Fellowes, chairman of the BMA’s prescribing sub-committee is
more philosophical. He says that without drug company sponsored
educational packages, there would be no seminars or training for doctors
because the Health Service does not have the funds to run them.
‘While doctors must be aware of the pharmaceutical industry’s commercial
motives, co-operation is common sense,’ he says.
Dr Fellowes favours the open approach which PR agencies bring to the
relationship between pharmaceutical companies and doctors. He is
concerned about direct marketing initiatives which US-based
pharmaceutical companies are attempting to bring to the UK: ‘Two US
companies are attempting to set up a system by which they can pay
pharmacists to supply the details of individual doctors’ prescribing
habits to pharmaceutical companies. They claim this would improve the
targeting of literature. But it raises concerns over confidentiality and
a possible flood of unsolicited advertising.’
Whether such initiatives take off, the globalisation of the
pharmaceutical industry, together with changes in the structure of the
NHS means healthcare PR agencies are under increasing pressure to come
up with novel schemes for their clients. Advisory boards are becoming
more and more common, leading to competition for experts.
Neil Kendle, managing director of Fusion, says the increase in expert
panels has made the market better for doctors, but tougher for PR
companies. ‘When we first started, our aim was to communicate clinical
matters. In order to attract doctors to meetings, we began to offer
training in presentation, business and editorial skills,’ he says. ‘With
the changes in the NHS, trusts now offer such training. We will have to
find another way to attract doctors to seminars and on to boards.’
The restructuring of the NHS has also brought new opportunities: ‘It has
broadened our range of targets,’ says Kendle. ‘PR agencies used only to
be interested in prescribers, like doctors and practice nurses. Now the
people involved in decision making are over and above the prescribers -
senior hospital management, the medical advisers and clinical directors.
They are what interest us now.’
Inform: Pursuing improved communication in patient trials
Inform, a clinical trial patient recruitment service launched by Cohn
and Wolfe in November 1995, is the first project of its kind in the PR
healthcare market. Unlike other PR educational initiatives it applies
proven communication disciplines to the clinical trials phase, prior to
the pre-marketing stage. While most industry protocols are data driven,
Inform is patient-centred.
Information in the Research of Medicine was created after extensive
research into the problems of patient recruitment and retention for
clinical trials. Cohn and Wolfe concluded that the market needed a
‘tangible, recognisable and credible brand’ to capitalise on new
business opportunities among pharmaceutical companies. It devised
Inform, a core communications package containing generic patient and
investigator materials and activities. Contents include a patient
information leaflet on clinical trials, an audio tape with a study
investigator answering a patient’s questions on clinical trials, press
material and overhead presentations for use at local patient association
meetings.
Inform’s appeal lies in its flexibility. The protocol package is
marketed to potential clients who can ‘pick and mix’ and tailor the
available tools and techniques to meet their specific trial
requirements. Cohn and Wolfe works closely with the clinical research
associates and local investigators of the pharmaceutical company to
define local issues and help the investigators communicate with GPs and
patients in the trial region.
Martin Ellis, director of Cohn and Wolfe, believes that structured
communications initiatives like Inform are essential to the success of
clinical trials. ‘If the industry continues its current practice -
independent of public perceptions and environmental factors - it will
fail to overcome the barriers to recruitment, retention and compliance,’
he says.
Proof of Inform’s success lies in Cohn and Wolfe’s expansion, both in
terms of staff numbers and fee income, since the service was launched.
It helped the agency to achieve a 17 per cent increase in fee income in
1995 and should account for 50 per cent of agency income by the end of
1996. Inform has been used in projects for DuPont and SmithKline Beecham
and has won Cohn and Wolfe several retained clients across diverse
disease areas. The agency claims that over 50 per cent of UK
pharmaceutical companies have requested further information about
Inform.
SmithKline Beecham plans to use Inform to support all clinical trials in
the UK. Dr Martin Woollard, head of research and planning at SmithKline
Beecham says: ‘Inform is a very clever, cost-effective yet simple
solution to our problem.’
Case study: Bates uses software to play doctor
Bates Healthcom, part of the Bates advertising group, is a ‘dedicated
healthcare agency’. It covers the broad spectrum of advertising,
marketing and PR and is involved in clinical trials, in forming ties
with opinion leaders and in the education of healthcare professionals.
Healthcom’s chairman, Mike Lees recognises that ‘doctors don’t like
being educated after they’ve left college’. As a solution to this
problem, the agency has come up with an award-winning interactive
software package, developed for Lundbeck, a pharmaceutical company
specialising in psychiatric medicines, in conjunction with psychiatrists
at the University of Southampton. Designed to be used by GPs in local
workshops, the initiative takes the advisory board format one stage
further - the knowledge of the opinion leaders is contained within the
software.
The package was developed in response to evidence that GPs have
difficulty in diagnosing depression. Its aim is to improve doctors’
diagnostic techniques and management strategies, using both drug and
non-drug options. In real time, and with digital sound and pictures of a
patient, it re-enacts a real-life consultation, giving the doctor the
opportunity to ask questions to which the patient replies. The programme
allows the doctor to examine the patient, suggest a diagnosis and
prescribe a range of drugs. He can even send out a health visitor.
When the doctor has finished his consultation, his performance is
assessed and he is told where he is going wrong. By typing in key words,
the package can also be used as a psychiatric medical dictionary,
teaching the doctor about psychiatric problems and the uses and abuses
of drugs, thereby refreshing his memory and bringing his knowledge up to
date.
Lees says the programme’s success lies in its evocation of a real life
consultation. Rather than sitting around a board table half listening to
discussion, a doctor becomes emotionally involved with the subject. It’s
also fun.
Lundbeck’s products are not overtly promoted in the software package.
Lees says this is the key to pharmaceutical marketing: ‘The best form of
promotion is covert. We don’t have to spell out that Lundbeck’s drugs
are the best. If the doctor is educated well, he will come to this
conclusion himself,’ he says.
Since its launch in January, the package has been presented to GPs at
over a thousand meetings and was praised at the World Psychiatric
Association Conference in Madrid. The agency plans to launch interactive
educational programmes across a range of therapy areas.
Case study: MAC initiates debate in the NHS
Medical Action Communications, the healthcare market leader, generated a
fee income of pounds 4.47 million last year. It puts its success down to
the consistency of its approach, good business planning and its in-house
medical and scientific team. Forums for Debate, a concept developed for
client SmithKline Beecham, is an example of the agency’s formula for
success, showing how a well-planned advisory board model can bond agency
and client and improve relations with NHS customers.
MAC devised Forums for Debate to give SmithKline Beecham an opportunity
to discuss issues directly affecting the planning and delivery of
health care with leading clinics and decision makers. Its aim was to
explore how all the parties could work together to achieve optimal
patient care. MAC determined topics for debate, identified appropriate
contributors and structured the meeting.
Chaired by microbiologist, Professor Michael Emmerson, the first
national debate was held in May 1995 and examined the role of
purchasers, providers, the industry and the patient in developing best
practice in infection management. Representatives present included the
chairman of a hospital trust, the director of the Patient’s Association,
fundholding and commissioning GPs and the marketing director of
SmithKline Beecham. The debate covered the needs of patients, rational
prescribing policies, diagnostic services, effective protocols and
working alliances between the various parties and industry.
Stephen Bullock, managing director of MAC, says that the meeting
exemplified the new direction being taken by the pharmaceutical
industry. ‘Traditionally the industry has always played the passive
sponsorship role,’ he says. ‘The difference about Forums for Debate is
that we placed our client at the table as a key player in the debate.’
Healthcare representatives are optimistic about future relationships
with the pharmaceutical industry. Linda Lamont, director of the
Patient’s Association says: ‘Information and education is where the
alliance comes in. The pharmaceutical industry has a hugely important
role to play here.’
MAC produced a report and a kit containing a video of excerpts from the
national debate for regional key account managers to use in setting up
local debates. MAC believes Forums for Debate has helped develop
important relationships with new NHS custom-ers and has raised the
perception of SmithKline Beecham to one of ‘Partnership beyond
Prescription’. The agency is now working with advisory boards at
international level.
