Forum Pharmaceutical Industry Image – Regaining the Trust Repairing the pharmaceutical industry’s tarnished image is a major undertaking that many believe has barely begun, and it’s larger than just a communications issue. All sectors of the industry need to unite behind a single message and purpose: to restore credibility to an industry that does tremendous good and has done more in the past 50 years to improve human health than any other industry at any other point in time. By Elisabeth Pena Villarroel Hugh O’Neill sanofi-aventis Patients need to identify and put a face to the pharmaceutical companies that make the products that they take. We have to be willing to put ourselves in front of the public as a partner in delivering healthcare, as opposed to being an uninterested third party. Robin B. Bartlett. President, American Medical Publishers Association, Huntington, N.Y.; AMPA is the professional association of healthcare publishers and related industry executives. For more information, visit ampaonline.org. Mr. Bartlett also is Director, Sales and Business Development, American College of Physicians (ACP); Philadelphia; ACP is the nation’s largest medical specialty association. For more information, visit acponline.org. Editor’s Note: The opinions expressed by Mr. Bartlett are not a reflection of those of the American College of Physicians or its journals, nor do they reflect the official positions of the American Medical Publishers Association (AMPA) or the Association of Medical Publishers (AMP). Stan Bernard, M.D., MBA. President, Bernard Associates LLC, Far Hills, N.J.; Bernard Associates is a healthcare and pharmaceutical industry management consulting firm that offers strategic planning, marketing, and business development services. For more information, e-mail [email protected]. Gary Bridi. Managing Director, Sentrix Global Health Communications, Short Hills, N.J.; Sentrix, a Sudler & Hennessey company, is a global healthcare communications agency. For more information, visit sentrixhealth.com. Eric Dezenhall. President, Dezenhall Resources, Washington, D.C.; Dezenhall Resources is an international crisis and issues management firm. For more information, visit dezenhall.com. Dan Grimm. Leader of BD Identity Campaign, BD, Franklin Lakes, N.J.; BD (Becton, Dickinson and Company) is a medical-technology company that serves healthcare institutions, life-science researchers, clinical laboratories, industry, and the general public. For more information, visit bd.com. Ken Johnson. Senior VP, Communications, The Pharmaceutical Research and Manufacturers of America (PhRMA), Washington, D.C.; PhRMA represents the country’s leading pharmaceutical research and biotechnology companies, which are devoted to inventing medicines that allow patients to live longer, healthier, and more productive lives. For more information, visit phrma.org. Mahesh Kolar. Product Manager, Discovery Laboratories Inc., Warrington, Pa.; Discovery Labs is a biopharmaceutical company developing proprietary, precision-engineered lung surfactant technology as surfactant replacement therapies for respiratory diseases. For more information, visit discoverylabs.com. Lynn O’Connor Vos. CEO and President, Grey Healthcare Group (GHG), New York; GHG is a global healthcare network that provides an extensive array of integrated services in support of brand acceleration and sales. For more information, visit ghgroup.com. Hugh O’Neill. VP, U.S. Integrated Healthcare Markets, sanofi-aventis, Bridgewater, N.J.; sanofi-aventis, with global headquarters in Paris, is a pharmaceutical company that develops leading products in seven major therapeutic areas: cardiovascular disease, thrombosis, oncology, metabolic diseases, central nervous system, internal medicine, and vaccines. For more information, visit sanofi-aventisus.com. Peter Pitts. Senior Fellow for Healthcare Studies, Pacific Research Institute, and Senior VP, Global Health Affairs, Manning, Selvage & Lee, New York; MS&L is a global public relations firm and a member of the Publicis Groupe SA. For more information, visit mslpr.com. Mike C. Pucci. VP, External Advocacy, GlaxoSmithKline, Research Triangle Park, N.C.; GSK, with global headquarters in Middlesex, U.K., is one of the world’s leading research-based pharmaceutical and healthcare companies. For more information, visit gsk.com. Ahnal Purohit, Ph.D. President and CEO, Donahoe Purohit Miller, Chicago; Donahoe Purohit Miller is a full-service healthcare advertising agency. For more information, visit dpmadvert.com. Nagaraja Srivatsan. Head of Life Sciences, North America, Cognizant Technology Solutions Corp., Teaneck, N.J.; Cognizant is a leading provider of services focused on delivering strategic information technology solutions that address complex business needs. For more information, visit cognizant.com. Ann Willmoth. VP, Commercial Operations, Commercial Development and Services, Solvay Pharmaceuticals Inc., Marietta, Ga.; Solvay is a research-driven pharmaceutical company and a subsidiary corporation of the worldwide Solvay Group of chemical and pharmaceutical companies with global headquarters in Brussels, Belgium. For more information, visit solvaypharmaceuticals-us.com. Frederic S. Wilson. Category Manager CME, Procter & Gamble Pharmaceuticals, Cincinnati; P&G Pharmaceuticals is a part of The Procter & Gamble Co., which has one of the strongest portfolios of trusted, quality, leadership brands. For more information, visit pg.com. David Winigrad. President, The Hal Lewis Group, Philadelphia; The Hal Lewis Group is a full-service healthcare communications agency specializing in creating and nurturing brands. For more information, visit hlg.com. Jeff Winton. Group VP, Global Communications, Schering-Plough Corp., Kenilworth, N.J.; Schering-Plough is a global, science-based healthcare company with leading prescription, consumer, and animal-health products. For more information, visit schering-plough.com. Joe Young. VP, Diabetes Brand Marketing, Novo Nordisk Inc., Princeton, N.J.; Novo Nordisk, with global headquarters in Denmark, is a focused healthcare company and a world leader in diabetes care. For more information, visit novonordisk.com. September 2005 PharmaVOICE The Industry’s image WHAT WENT WRONG? At one point, the U.S. pharmaceutical industry was renown for its innovation and for bringing modern medicines to the market. Today, some polls show that the industry, which continues to provide innovative, lifesaving treatments, ranks lower than the tobacco and oil industries. It’s clear that something has gone wrong, especially since the pharmaceutical industry, once viewed as providers of lifesaving and enhancing medicines, is now regarded as one only focused on profits. Young. The industry has not used the media to its advantage, but it is the most important vehicle to leverage when communicating the value of pharmaceutical companies to stakeholders. PhRMA has recently addressed this issue and has launched a consumer-awareness campaign to try to dispel the common misperceptions about the industry. For companies to leverage the media as a means to define pharmaceutical value, the industry must take several steps. It must provide solid and accurate information that is consistent throughout the industry; allow access to, and provide informed opinions from key executives for journalists to use as a resource during critical junctures; and position pharmaceutical companies and their products compared with other industries, in terms of the value proposition. Grimm. Companies are doing good work, more than the public ever hears about. Today, because of the overwhelming number of messages the public is exposed to, companies have underestimated the need to reach out and tell their stories over and over again in a way that the average person can digest and understand. Beyond that, the industry needs more than stories; it needs to have the commitment and discipline to maintain a consistent communications plan. O’Neill. The industry has fallen short because it has historically been in the middle of the healthcare system in the United States. Companies develop and bring to market products, but they don’t directly touch the patient or the end consumer. The other intermediaries, such as physicians, payers, wholesalers, retailers, and pharmacists, have the direct contact. For many years, companies have been two or three steps away from actual customers and patients, and they have become isolated. We need to refocus the message that our products benefit patients’ lives, and we need to get away from an isolationist, big pharma mindset. Winton. Because of the competitive nature of this business, companies have gone after one another rather than promoting a values-based message on a unified front. As a result, the public is exposed to combativeness. This is changing, out of necessity, I believe. But the fact remains that the public perceives companies, whether it is through DTC advertising or other methods, to be knocking down competitive products. As a result, people don’t recognize the collective good that a class of drugs can have on patients with a specific condition. Within the marketing mix, whether it is a sales call or public relations or DTC, people tend to pick up on the negative and remember the negative more than they do the positive. We have a responsibility to each other to make sure that the lasting impression that we leave with the end users of our products is positive. Johnson. For years, the industry tried various advertising campaigns to define itself to the public, decision makers, and opinion leaders. But even as medicines did more and more to save and improve lives, resentment toward the industry still grew. Bartlett. Pharma companies have always advertised to physicians, but these days they are going directly to the consumer more than ever before. While DTC has been effective for them, pharmaceutical companies have pushed the envelope too far and that is now coming back to haunt them. Controls have started to come into place. First there were PhRMA’s self-regulatory guidelines, and now the FDA is stepping in to evaluate certain types of DTC advertising. Pharmaceutical companies need to take a long, hard look at the way they apportion their advertising spend. O’Connor Vos. Six or seven years ago the industry was not as well known by many consumers because its products weren’t on television. With the advent of DTC, consumers started to recognize the industry, and they started to become more curious, which led to more publicity about the industry. And then the media started to do its own investigations. In some cases, the publicity has been very negative and has not contributed well to the overall reputation of the industry among consumers. Pitts. Despite popular beliefs, most people do not get the majority of their information about health issues and options from ads. They get it from the news media. In my opinion, it is more dangerous for a news story to overstate the benefits and underplay the risks of a drug than a pharmaceutical advertisement because news stories have greater credibility. It’s the job of the healthcare communications professional to take the truth — the message and the facts — and make it not more sexy than fiction, but make it more memorable and more important for all the right reasons. Direct-to-consumer ads have to play by certain rules that journalists do not. DTC ads have to be “fair and balanced.” Journalism does not. Ads have to provide “adequate provision” for risks versus benefits. Journalism does not. How many times has a company executive called a reporter to complain that a story on its new product was too positive or too effusive? How many times has a company rep called to complain that a story didn’t talk enough about the risks? Balance is in the public interest and in the best interest of the industry. My argument is that the more balanced the presentation, the more believable the message. And, from a communications perspective, a believable message is more effective. This is a magnificent opportunity for public relations to ascend to the podium of communications prominence. Dezenhall. By nature, communications and PR people don’t like to deliver bad news. The reality is that medicines don’t get to market without expensive investment in R&D, and new medicines are not free. This is not a “happy” message to deliver. What has been missing from the communications mix are messages specifically designed to make people recognize that there is a cost involved with developing new and effective treatments. Communications firms and pharmaceutical companies drive themselves frantic to communicate happy thoughts and happy news, but reality isn’t always happy. That doesn’t mean the message shouldn’t get out there. Willmoth. The industry does communicate a positive and honest message to the public. There are always going to be specific interest groups and parties that have opposing views to the messages that we are communicating, and today our industry is experiencing this in much the same way as many other industries have experienced before. Despite that and what is going on today within the political arena, I think we have to continue to focus on and share the positive message about the industry with the public. In 2004, the industry spent almost $50 billion researching new drugs, and 22 million prescriptions valued at almost $5 billion were subsidized by drug companies. What we have to do is consistently communicate that positive message about the things that we are doing. We can’t control the opposing views, but we can be vocal about the good things that we are doing. Winigrad. I don’t believe advertising agencies have fallen short in communicating the industry’s message because for the most part this has not been their responsibility. Agencies, by and large, are charged with the task of communicating positive and honest messages about particular drugs. Unfortunately, the net effect of these efforts has not altered the overall perception of the industry. If agencies were employed to communicate about the industry at large, there would be more consideration around each brand in terms of how it reflects on the industry in general. Wilson. PhRMA has not effectively educated the public. For example, the public doesn’t know that in most states physicians are required to take so many hours of continuing medical education (CME) each year and that the pharmaceutical industry provides the funding for more than half of that CME. The public doesn’t know that primary-care physicians can only maintain their memberships in their medical associations if they meet certain CME requirements, and these associations also benefit from the financial support of the research-based pharmaceutical manufacturers. CHANGING THE COURSE Actions speak louder than words. While pharmaceutical companies need to communicate their positive messages to the public, experts across the life-sciences industry agree that all industry stakeholders can play a part in ensuring the messages are heard. Winton. A positive to come from the current DTC controversy is a return to the basic message of disease awareness and making sure that the marketplace is educated on a particular disease and various treatment options. This may mean walking away from brand-specific communications in certain cases, and I think this is something that needs to be considered. There need to be more campaigns analogous to those in markets outside of the United States where brand-specific DTC is not allowed. In those countries, advertising and public-relations campaigns are very disease-specific and educational in nature. In those markets there is not nearly the public backlash against the industry as there is here. Also, by allowing patients and others from the outside to peek behind the curtain we can change opinion, but pharmaceutical companies need to start opening up their doors more. At Schering-Plough, we are committed to opening the company to patient groups, physician groups, and reporters to allow them to witness the inner workings of the company and the dedication inherent in bringing drugs to market. Dezenhall. The big challenge to overcome is that people, by nature, believe they are owed healthcare, and they bitterly resent having to pay for something that they think is an entitlement. I am skeptical that we can communicate our way around human nature. But one way to attempt this is to be brutally honest and remind consumers that there is, for example, a potential cure for Alzheimer’s disease. But when it is found, they will have to pay for it. It is very hard to communicate such a blunt truth to consumers, but at some point there has got to be a voice that reminds people of this uncomfortable reality. As a culture, we have developed an evangelical faith that public relations can spin anything, and I don’t think this is possible any longer. What I do think is possible is a more assertive effort to communicate how lives have been changed by medication. For example, there aren’t many messages that have a patient saying his or her life was a mess before taking Zoloft, for example, because healthcare and disease are very personal. People would like their lives to improve, but they don’t want to talk about it or tell a company how their lives are improved. We need to remind audiences that the human body is a series of organs that is substantially improved by pharmaceuticals. Winigrad. With regard to industry communications, agencies can ensure the tone of promotion is commensurate with the practice of medicine. Drugs are not discretionary purchases, therefore they can’t be sold like packaged goods. When drugs are promoted in a way that appears to be too overtly commercial, it creates opportunities for criticism and negative publicity. Agencies can become part of the communications process in developing messages around the access issue and actively promoting patient-assistance programs and other programs the industry provides along side the drugs that they promote. In effect, they are making access part of the value proposition of the drug itself. In addition to talking about how a drug has great efficacy and safety, agencies can also promote that the drug is accessible to the people who need it. Bartlett. If pharmaceutical companies took 1% of their DTC budgets and shifted those resources to professional journal advertising, it would literally double the number of communications going to the professional marketplace. That 1% is more or less the equivalent of the 15-second reminder advertisements that pharmaceutical companies have already agreed to discontinue. Companies need to recognize and remember that physicians prefer to receive information about new and old medical entities through journal advertising. Such a shift in apportionment would begin to form the basis of a new marketing paradigm that would be very beneficial to pharmaceutical companies, to the medical journals, and to the physicians. Journals must devote sufficient resources to publish high-quality, fair, and unbiased peer-reviewed research about pharmaceutical products, as well as new medical procedures and new scientific advancements. Pharmaceutical companies should support that activity with a commitment to long-term professional advertising and by carrying reprints to the field. O’Connor Vos. Despite the fact that doctors are so highly regarded by patients, the industry’s reputation continues to move further down the continuum. There should be a positive halo effect when physicians sit with patients, but there isn’t. Part of the reason is that the industry, to some extent, has alienated the physician community. From a communications industry standpoint, we should focus on a more consultative sell, create an opportunity to engage the physician in a dialogue rather than a monologue, and find ways to help doctors facilitate better communications with their patients. Establishing a relationship with physicians that is based on the physicians’ real needs to improve patient care is a huge opportunity that exists for the industry right now. If we do that, we can improve our relationships with doctors, which should have a positive effect on how the public views the industry. Bridi. We can refocus the value proposition and rebuild the trust by developing more transparent communications and letting people see that what the industry does has their best interests at heart. Some ways to do this include making study data broadly available and conducting comparative trials within classes of products. Another avenue of communication is showcasing the many people employed by the industry, who can act as spokespeople if they have the right information. They talk to their families and friends at cocktail parties, little league games, picnics, and so on; there is a tremendous opportunity to communicate with the public through our employees. Johnson. As an industry, we need to get away from relying solely on facts and figures and start talking about the real-life human dramas that patients live every day. We need to emphasize the strength of the industry’s pipeline and trumpet the huge number of lifesaving medicines the industry is developing, such as the 399 new medicines currently in development for cancer. We need to talk about the men and women in the pharmaceutical research industry who get up every morning with one goal in mind: developing new, innovative medicines that save lives and improve the quality of life for millions of Americans. We have to do a better job to educate and communicate with the public. The industry needs to bring everything down to a personal level. The more people reflect on the positive impact that medicines have on their lives, the more positive the association with the companies that make those medicines. Srivatsan. To rebuild trust, communications must be clear and correct. By having a framework and standardization of information, communications with physicians and patients can be more targeted. An effective communications platform can open the dialogue around risk, for example, so that pharmaceutical companies can be more proactive about building trustworthy relationships. Information technology also can help pharmaceutical companies assess their needs across different silos within life-sciences organizations and provide solutions to bring everything together. Breaking through the silos will deliver bottom-line cost reductions and provide companies with a clearer picture about the safety of their products, all of which will resonate with the public. IT companies can play a big part in helping the industry regain trust by building the right information infrastructure so companies can make the right decisions about their products. Grimm. A comprehensive program is more difficult to implement than just changing or increasing communications. I am responsible for BD’s identity program, where we describe humanitarian healthcare initiatives. One part of the program involves messaging, but another involves giving our 25,000 associates the opportunity to get out there and roll up their sleeves. We launched the BD Volunteer Service program, where our associates are sent into a developing nation to work for a couple of weeks. In May, we took 10 people to Zambia to work in HIV clinics for a nonprofit organization. BD pays for everything, and volunteers don’t need to use vacation time to participate. We also support these clinics with product donations. Wilson. All patients know about the industry are prescriptions and what they cost, either through their insurance company or from out-of-pocket expenses; they never see a human being connected with the industry. At the PharmaVOICE Marketers KnowledgeShare Forum in June, we were posed this very question. My team’s solution was for pharmaceutical companies to have their sales reps and medical science liaisons (MSLs) devote one day a year to volunteer at kiosks in local pharmacies or at accessible street-level offices to assist elderly patients and uninsured patients in accessing and filling out Medicare and drug reimbursement forms so they would have access to the free medications that are made available by the industry. This would be a public service and would put a face to what the industry is all about; this would also be an interesting learning experience for the pharmaceutical sales reps and MSLs. In this way, the industry can transition from being viewed as a money-hungry institution to one that is comprised of people who are providing and facilitating improvements in healthcare. Also, the public needs to be consistently exposed to the positive impacts of effective pharmacological therapies, such as fewer health-related work absences, shortened hospital stays, improved quality of life despite chronic disease, and reduced mortality from cardiovascular disease or multiple forms of cancer. Bernard. My advice is for the industry to go back to the basics of marketing and start by developing a single, unified positioning and branding strategy with corresponding key message points. Pitts. Pharmaceutical companies can no longer have their public policy people in Washington, D.C., and their brand management people at headquarters and expect that both teams understand what the other is doing. There has to be strategic coordination and a more hybrid team approach, wherein the PR team includes a policy liaison. Also, the industry needs to change a lot of its behavior because even though media coverage is relatively negative, it doesn’t mean it’s all untrue. The industry has to modify its behavior so reporting follows suit. And from a management standpoint, the industry needs to be much more aggressive in its portrayal of itself as healthcare heroes. It can’t let bad stories go unanswered. O’Neill. As pharmaceutical leaders, we need to be as direct as we can, obviously taking into account legislation and privacy issues, with our consumers and patients. And I don’t mean in the form of DTC. We have to actually help people understand how our products fit their disease state and how we can assist them to reach their healthcare goals. And for credibility purposes, we need to communicate that our products aren’t right for everybody and that patients should look at other therapeutic options. We need to be about getting the right patient the right drug at the right time. Embracing those messages and shaping the promotion and positioning of our products would go a long way to change negative perception. Young. Pharmaceutical companies are providing immense value to society at large. To be accountable for contributions, companies need to respond to stakeholders’ concerns in a transparent way. PhRMA is working to help the industry communicate this value through a public-outreach campaign by highlighting individual pharmaceutical companies, lifesaving treatments, and emerging therapeutics. Kolar. We need to focus on the benefits and not just the pricing by providing appropriate education to the public. But the important thing is that the industry comes together as one group. If we could pull together as an industry to create a strong coalition, this would go a long way in communicating the positives of our mission. Willmoth. The most vital thing that we can do as an industry is to focus on the No. 1 objective that we all share, and that is to improve the quality of life for patients. Another thing that we have to do is continually monitor how best to serve the needs of our stakeholders, who are all the people we interact with from a customer perspective, including our patients. We need to constantly look at what we offer in terms of value-added services so that we make sure our customers have what they need to meet a changing landscape. The pharma industry has to be very vigilant and aware of the trends in the marketplace and must be able to respond quickly to offer benefits to patients and physicians. PROFITS AND PRICING Underlying much of the public’s criticism of the industry are pharmaceutical company profits and the prices of medications. Communications need to move the spotlight away from these charged areas and focus on the ways the industry benefits society. Bridi. For too long, the industry’s response to public concern about drug prices has been that prices are what they are because it costs $800 million to get a drug to market and there is a need to fund future research. This has never been an effective message. And even as public opinion sways in the wrong direction, the industry continues to communicate this message. We need to get back to the value proposition. People do not want to buy pharmaceuticals, and the purchase of medicines shouldn’t be considered the same as the purchase of cars or clothing. From an economic standpoint, people reject higher prices or resist paying for medications at all in some cases. As an industry, we need to do a better job of explaining why medications are valuable and what it takes to get a drug to market, and this message must be focused on the value that accrues for the customer. Pitts. Pharmaceutical companies are the current bêtes noires of American healthcare, and they are an easy target. The highly politicized debates over drug importation, Medicare reform, and DTC advertising show that there are no simple answers to why drugs cost what they do in the United States and why they cost so much less in other countries. Complicated questions of market economics, R&D investments, international trade, and government regulatory policy make easy answers impossible and simplistic ones unacceptable. As an industry, pharma has failed to address the question of cost in a way the public is ready to understand and willing to accept. To date, the industry has argued that the price of drugs is the price we pay for innovation. And while that’s true, it’s as much a threat as an explanation. Winton. The price issue is never going to totally go away, but certainly it would be much less of an issue if people truly understood what the drug-development process is. But it can’t just be the pharmaceutical industry, or a specific company, doing the explaining on its own. Patients have more credibility than the industry has, and they can help us tell the story. Bernard. The pharmaceutical industry stands tall in the marketing of its products but has fallen short in the marketing of itself. As an industry, we have not firmly established the positioning in the minds of key stakeholders. Because we haven’t stepped into the void to create the positioning or proper perception of the industry, our critics have jumped into that void and consequently created a very negative perception, emphasizing our pricing and profits. O’Neill. The No. 1 thing we need to do as an industry is to get people to understand why our products add value to their lives. That means we need to focus on the value or benefit that the drug provides, not only to physicians, but more importantly to patients. The pricing issue is being driven by the fact that people don’t understand why a product is prescribed or what the product actually does for them as it relates to their overall health. We need to shape a message so that consumers, physicians, payers, and policymakers can understand the value of pharmaceuticals as it relates to a percentage of the overall healthcare dollar, as opposed to the actual acquisition cost. Johnson. Up until this year, the cost issue has been molded almost entirely by those trying to undermine the pharmaceutical industry, and as an industry, we have often responded reactively — instead of proactively — to that hostile agenda. Pricing, safety, DTC, access issues, and profits dominate press coverage and public opinion. On all of these issues, we must begin to define the problems — and the solutions — on our terms. On issues such as importation, we are proactively shining the spotlight on safety, public health, and the national security consequences of opening our borders to foreign drugs. At the same time, the industry is offering real-world solutions to access problems through the Partnership for Prescription Assistance (PPA), which helps people in need obtain free or nearly free medicines. In addition, we need to refocus the healthcare debate on the terrible cost of disease, which is the real problem in America today. O’Connor Vos. A big turning point in terms of improving the image and reputation of the pharmaceutical industry may come through the new initiative by PhRMA, which has finally developed a program that will provide greater access and is promoting the fact that the industry is working hard to ensure that consumers who can’t afford medications will have a way to get the medication paid for either by industry or government. O’Neill. The member companies of the industry need to focus on action first: reaching out and providing access to our medications to patients who can’t afford them and being very open about programs for patients and their families that give them greater access to the medications they need. The industry, and sanofi-aventis as a founding partner of Partnership for Prescription Assistance, has been very active in providing access to medications to patients who can’t afford them. But the industry has historically been very hesitant about making these initiatives publicly known, and it is really up to us to be much more up front about all the work we are doing here and in third-world nations to improve access to lifesaving medicines. Young. On an industrywide level, PhRMA is making great strides in helping to communicate the benefits of medicine and the societal contributions of the pharmaceutical industry. But individual companies must continue to communicate their value proposition to stakeholders so the industry will benefit as a whole. For example, at Novo Nordisk, we strive to conduct our activities in a financially, environmentally, and socially responsible way as part of our underlying business principal, the Triple Bottom Line. To make sure that Novo Nordisk is acting on its commitments, the company measures its activity on a yearly basis through key performance indicators and publishes the results in an annual sustainability report. Winton. The industry became very bottom-line focused. Obviously, Wall Street continues to put a lot of pressure on companies, and decisions have been made that are probably more short term than long term. Long-term decisions, especially regarding the image of a company and the image of an industry, will not necessarily yield immediate results. Because companies have shareholders that they are responsible to, they haven’t always been focused on the long-term proposition of promoting the good that the industry does. COST AND CONSEQUENCE The experts participating in this Forum agree that the consequences of allowing the industry to continue to be viewed negatively far outweigh any cost involved with changing practices and communications. Pitts. The consequences of doing nothing are profound and could result in a move toward socialized medicine, which would end a market-based pharmaceutical industry in this country. That would be an awful setback to the public health, as well as to the way companies do business. If the industry continues to allow itself to be demonized, there will continue to be no negative consequences for public officials who pass punitive laws that are popular but extraordinarily bad for the public health. Young. The industry relies on public acceptance to be able to innovate and operate. Without public trust and support, breakthrough medicine, research, and development will not progress as they should. The healthcare industry has an immense societal impact on providing employment opportunities, on developing breakthrough medicine and science, on investing in the economy, and most importantly, on improving individuals’ quality of life. The industry must join forces and communicate its value proposition in one unified voice. Bartlett. The consequences of inaction are more government regulations. The government will exercise greater control over what pharmaceutical companies can say on the airways and increase requirements for warnings about adverse reactions. Pharmaceutical companies are out of balance with the public, and the public is starting to rebel. If pharma does not self-regulate, people will seek other sources for their information about new and old medical entities when they should be going to physicians as the primary sources of information. O’Connor Vos. This is a fantastic industry. It is the one industry that can be credited with actually making significant strides in improving patients’ quality of life and, in some cases, actually maintaining life for patients. There is still a desperate need for breakthroughs in areas such as lung cancer. We need the pharmaceutical industry to remain strong to help bring us those revolutionary products. The consequence of allowing this negative perception to continue could be devastating for society and impact innovation in healthcare. Universally, everyone agrees innovation is needed. Everyone wants to live longer and better. Winigrad. The consequences of doing nothing will be draconian regulations and ultimately will lead to price controls and legislative action. The industry must respond. The industry needs leadership that fundamentally sets forth a vision that every American who needs a particular drug gets that particular drug, regardless of his or her circumstances, insurance, financial condition, and so forth. When that leadership and vision emerge and the reality of it is seen on the ground, then there will be no room to criticize the industry, particularly for being profitable. Many industries are very profitable, and they don’t receive the kind of criticism that pharma does. Our industry needs to focus on making sure that people get the drugs that they need and move the argument away from cost and pricing. O’Neill. The pharmaceutical industry has to be willing to let go of the current model. I don’t think the financial cost to the industry to do so would be great. The industry must step out from behind the curtain of anonymity as it relates to the U.S. healthcare system. Taking no action will result in legislation or direct interaction from a federal and state level or, even worse, entirely losing the trust of the U.S. public. We are at a crisis point now, and the consequence of no action will further the demonization of the industry as an offline cause of the problem as opposed to a potential partner in providing solutions to the U.S. healthcare system. Dezenhall. The public understands villains and victims. The cost of ignoring the situation is that the pharmaceutical industry will be villainized. My experience has been that industries have to spend extraordinary sums of money just to remind people that they serve a purpose. The problem is that boards of directors don’t want to hear that expensive communications programs, which need to run indefinitely, have no measurable return; but the constant process of reminding audiences of the industry’s purpose is absolutely necessary. The cost of not doing anything is that in 10 to 20 years, the pharmaceutical industry will be a publicly regulated utility as opposed to a capital enterprise. Grimm. The real cost is an organizational commitment to change and the diligence to follow through. This is much harder than spending $1 million on a campaign. A large pharmaceutical company can usually find money to fund a program. But having the commitment from the top of the organization that the company is going to support change and that the associated costs aren’t subject to yearly review is much more difficult. Johnson. The cost of regaining the public’s trust is hard work, and there must be a sustained commitment to educating, advocating, and communicating the good things about the pharmaceutical industry to the American public. There will be serious consequences if we fail to act; the fate of America’s free-market healthcare system is at stake. Rationing of healthcare and medicines, socialized medicine, restricted formularies, and bureaucrats managing health decisions are all possible results of industry inaction. Willmoth. The consequence of doing nothing will be continued negative perception. It is our responsibility to clear up any misconceptions. We need to consistently communicate and use the resources that we have to talk about patient benefits and what we are doing to enhance, as well as save lives. It really isn’t a choice; we have to continue to address perception issues. Wilson. The cost of regaining the public’s trust is nominal in comparison with the consequences of no action. The public wants the best possible healthcare at the lowest possible price. Understanding the shared objectives between pharmaceutical companies and the learned intermediaries — physicians, physician assistants, and nurse practitioners — and ensuring that the latest approved therapy is prescribed accurately whenever indicated would be in the public’s best interest. Kolar. The cost to repair the industry’s image may be tremendous, but in the long run it is important that it is restored to its former stature. An effort to improve the public’s perception of the industry would help its employees and the people it serves. If the public understands what we do, why we do it, and how we do it, there would be a better understanding of the value we deliver. Bernard. It is essential that the industry regain the trust of its key stakeholders. If we do not regain the trust and continue with the status quo, we will continue to experience repercussions. Most importantly, we will lose the opportunity to innovate, commercialize, and distribute our products, which have done more to enhance the well-being and extend the lives of millions of people than the products of any other industry. Winton. We are at a point where we have no choice; if we are going to regain the public trust we have to do whatever it takes, even if it means drastically changing the way that we communicate. We are in a crisis situation right now; every morning the papers are filled with negative articles. We have a lot of work to do, and I am not convinced that we have a lot of time to do it. Things are at a point where we have to start to change how we approach the public. We have to start proving that we believe in what we say and do, and we need to make drastic changes that will show the public that we are serious about regaining their trust PharmaVOICE welcomes comments about this article. E-mail us at [email protected]. Creating Industry Ambassadors There are many successful ambassador-based company programs. Executives interviewed for this Forum have provided the following experiences as examples of particularly successful efforts. Mike C. Pucci GlaxoSmithKline The grassroots portion of our Value of Medicine campaign is raising the awareness that the industry employs people in the local communities and that pharmaceutical companies, such as GSK, care about access and affordability of their medicines and have programs to help those in need. Teaching the Value of Medicine In response to the erosion of the industry’s reputation, GlaxoSmithKline (GSK) launched its Value of Medicine campaign in July 2003 to tell the industry’s story proactively and to more effectively respond to current issues. With its stated goal of restoring the reputation of the industry by communicating the value of its products, research, and hope for the future, GSK is attacking the problem with a three-pronged strategy: a grassroots campaign using the salesforce as well as medical and executive speakers; a national media campaign; and a collaboration with WebMD. The importance of the grassroots element of the campaign is two-fold. First, it empowers all of our 25,000 U.S.-based employees to be able to answer questions about our industry with a positive value message to friends, family, customers, and people we come in contact with on a daily basis. Studies have shown that information conveyed by our staff is highly effective in moving public opinion about our industry. Since we have employees based in nearly every city in the country, we are leveraging a national network of highly skilled employees to tell the story about how our work benefits people who suffer from disease and how our profits are plowed back into research to work on the next generation of miracle drugs to treat diseases we don’t treat very well today. The media portion of the campaign consists of scientists from GSK labs telling their own story about why they are inspired to work in the industry in research, and it’s no surprise that their stories are all about patients and helping people. The ads associated with this program carry the tag line “Today’s miracle drugs pay for tomorrow’s miracle drugs,” which emphasizes the importance of the cycle of research being dependent on revenue earned today. In addition to national media spots, a number of individuals have been trained to talk to local media, and the company plans to be very visible in the year ahead in small market media — in person to put a human face to its business with a proactive and positive message. GSK also contracted WebMD to create a Value of Medicine Website with links to patient-assistance and disease-management programs. The response from GSK employees to the campaign has been overwhelmingly positive and supportive. Employees are excited to have their side of the story being told and often inquire as to when they can be trained to speak on behalf of the industry. Morale at the company has improved as people see that GSK is putting its best efforts forward to defend and promote the important work its employees do. Dr. Ahnal Purohit Donahoe Purohit Miller The thousands of people working in pharmaceutical communications can and should play a vital role in becoming ambassadors for the industry. To make these individuals as effective as possible, it is our responsibility to educate them well on the issues facing the pharmaceutical industry. A Communications Strategy To encourage the thousands of people in the pharmaceutical industry to become ambassadors, there is an essential need for education. Education will increase the confidence and comfort of employees communicating with their friends and families and succinctly telling the “other side of the story.” The combination of reach, frequency, and impact of communication will generate far superior ROI than any potential tactic that could be employed in the pharmaceutical/ communications industry. There are several initiatives we have set in motion to educate our staff, including a standard column in our agency newsletter covering new industry issues and an ongoing Q&A posted on the agency intranet. Additional measures that would be effective and that we may employ include: the coverage of “hot issues,” including industry perspective and rationale, in staff meetings; lunch and learns centered around various pharmaceutical ads, in which participants critique ads and discuss positioning, main messages, and impact on consumers and then discuss ways in which one should communicate these messages to friends, family, and other consumers; and the inclusion of industry issues on our managers’ meeting agenda, during which we discuss why it is important to address these issues, their role in championing the pharmaceutical industry’s message, and ways to communicate that message most effectively. Ann Willmoth Solvay Pharmaceuticals The purpose of this type of communication campaign was to educate and inform our own employees about important industry issues so they can be ambassadors on behalf of the industry. Solvay Pharmaceuticals’ Industry Advocates Program Launched in 2005, Solvay Pharmaceuticals’ Industry Advocates program was established to harness the potential for employees to serve as spokespeople for the industry. Executives at Solvay Pharmaceuticals believe that with the facts in hand their employees can speak confidently about the issues with their friends, neighbors, and relatives. Many of the communications between industry employees and the public are not things that happen in the workplace; they are conversations that happen in day-to-day interactions with neighbors, friends, at church, or at a kid’s soccer game. The program’s mission is to arm employees with the essential facts on important industry issues, so they can serve as ambassadors, sharing news of the good work that we do and clarifying common misconceptions. Before launching Industry Advocates, we had received several requests from employees for information they could share with their families, friends, and business colleagues when these topics came up in conversation. We worked to provide them with the resources they would need to articulate our position on these issues. Since launching the program, it’s been reassuring to see Industry Advocates materials hanging on employees’ bulletin boards around the office, which is a real sign that they are absorbing the information and referring back to it as necessary. We will continue to evaluate how best to further expand or develop the program as issues arise or feedback from employees points us in a new direction. Topics addressed by the program to date include research and development, patient-assistance programs, direct-to-consumer advertising, cost of healthcare, drug spending, price controls, and importation. The multimedia campaign reaches employees via Intranet, printed collateral, and Solvay Pharmaceutical’s employee magazine. PharmaVOICE Reader Survey Ambassador Programs PharmaVOICE asked its readers: Does your company provide you with the information and support to be an ambassador to help communicate the industry’s positive message to family and friends? Response Yes 37.2% No 62.8% Sound Bites from the Polling Field We focus on living our corporate brand and demonstrating the attributes around delivering innovation, being reliable and trustworthy, actively listening to customers, and networking our medical expertise. The company provides talking points to critical questions facing the industry. But we have not been proactive enough to combat the negative perceptions. Senior executives speak out on issues. We try to guide our clients to new communications solutions that will support trust building. We have companywide updates, discussions, and talking points for employees. There are weekly CEO seminars and Q&A sessions. It’s not so much what is done, but more the manner in which we speak of the drug industry. Senior people tend to talk more about the positive aspects of our industry, and the junior people learn from that. My company doesn’t do much; I do it on my own as I’m proud of the industry. We have the best and the brightest, and we shouldn’t be defensive or apologetic. We should educate our detractors. We have a corporate goal of alignment with our philosophy and messages. This is achieved through our various internal communication tools, reiterated at all-hands meetings, and encouraged through a series of opportunities for staff to be recognized for helping to achieve the goal. We have extensive training programs from introductory classes to classes for managers. There are regular updates and communications on key issues in the press and the company’s position relative to them. We receive information principally through a series of pep talks from our upper management. Admittedly, there could be more basic-level emphasis on this important topic. Besides providing materials, management makes sure there are many real-life spokespeople, many of whom are company employees who have a personal tie to the particular disease state they are supporting. We receive consistent messages regarding company values and guiding principles. Also, we receive routine information regarding compliance and how to report unethical practices anonymously. We receive slide kits and are told to go forth and deliver, but management does not prepare us well to respond to open questions from audiences who may be emotional about our message. This effort by the industry has been ongoing for a number of years but does not seem to be working well or making an impact. We have “consumarized” brochures and slides that lay out the value our industry provides. We are truly reaching out to understand our customers’ feelings and to ensure we are customer-centric in all of our activities. Source: PharmaVOICE, Titusville, N.J. For more information, visit pharmavoice.com. Note: The 242 respondents to this question include the following types of companies: 25.1% pharmaceutical, 23.9% marketing/communications supplier, 7.8% biotechnology, 7.8% contract research, 7% service, 4.5% information technology, 3.3% biopharmaceutical/biology, 2.5% device/diagnostics, 1.6% drug development/clinical-trials consulting, 1.6% media, and 14.9% other. Robin Bartlett American Medical Publishers Association, American College of Physicians If future promotional efforts concentrate on the good things that pharmaceutical companies do and these messages are seen enough times, this is what the public and physicians will start to remember. Too many of the messages the public now sees from the industry are DTC ads with branded sexual innuendo and cartoon characters. Dr. Stan Bernard Bernard Associates As an industry, we collectively have to agree on and establish a single positioning that refocuses on industry value and product benefits. A product manager wouldn’t dream of letting each sales rep deliver a different product message, yet each pharma company delivers its own distinct messages about the industry. Gary Bridi Sentrix Global Health Communications For too long, the response to criticism that drug prices are too high has been that prices are what they are because it costs $800 million to get a drug to market. This has never been an effective message. David Winigrad The Hal Lewis Group Advertising is not the total solution to the problem. The programs and actions pharmaceutical companies take to ensure access to patients ultimately will go much further to change minds and silence critics than advertising alone. Frederic Wilson Procter & Gamble Pharmaceuticals The only thing patients currently see of the industry is a prescription and what it costs; they don’t envision a human being connected with the industry, and this needs to change. Peter Pitts Pacific Research Institute The biggest challenge is remembering that pharmaceutical public relations is a tripartite proposition — driving sales, enhancing reputation, and advancing the public health — and not necessarily in that order. Pharmaceutical companies are in the healthcare business. That’s easy to forget, but it must be at the heart of every strategic public-awareness program. Mahesh Kolar Discovery Laboratories What people don’t see and hear about on the news is the passion that people in biopharma companies have to ensure successful products are available to patients. For those of us working on these medicines, the end result is about much more than profits. Nagaraja Srivatsan Cognizant Once the industry regains the public’s trust, it will have to protect the integrity of that trust. Trust needs to be built in many dimensions: transparency of information to the public all the way through the clinical-trial process through postmarking. Jeff Winton Schering-Plough What the industry does is all about the patient in terms of what drugs can do to extend and save the lives of patients. We are beginning to communicate this message better, a premise that perhaps the industry lost sight of earlier in the game. Joe Young Novo Nordisk The industry must demonstrate the value it provides to patients and the healthcare providers who serve them through available and emerging treatments that improve quality of life, as well as through research and development, educational initiatives, and prevention programs. PharmaVOICE Reader Survey Communication Methods PharmaVOICE asked its readers: What do you believe is the most effective method for further educating consumers about the value that pharmaceuticals bring to healthcare? COMMUNICATION METHOD Television 48.8% Live, Local Events 8.3% Publications 11.2% Radio 1.7% Internet 7.9% Other* 22.3% *Responses for the Other category included: advocacy-group relationships, direct mail, fireside chats, healthcare professionals, patient testimonials, peer-to-peer communications, public hearings, town hall meetings, and waiting-room literature. Source: PharmaVOICE, Titusville, N.J. For more information, visit pharmavoice.com. Note: The 242 respondents to this question include the following types of companies: 25.1% pharmaceutical, 23.9% marketing/communications supplier, 7.8% biotechnology, 7.8% contract research, 7% service, 4.5% information technology, 3.3% biopharmaceutical/biology, 2.5% device/diagnostics, 1.6% drug development/clinical-trials consulting, 1.6% media, and 14.9% other. PharmaVOICE asked industry experts to discuss PhRMA’s recent DTC guidelines, as well as the communication vehicles the industry can use to reach out to consumers given the scrutiny around DTC. Leisa Dennehy is Cofounder and Managing Director of BioPharma Consultants, Raleigh, N.C., a management consulting firm specializing in marketing, strategy, and business development services for biotech and pharmaceutical companies worldwide. For more information, visit biopharma-consultants.com. “The best approaches to targeted patient contact, which is commercially justified in an era of skepticism about DTC advertising, are patient advocacy groups and use of the Internet. Both these media have two-way touch points; the patient or family member is reaching out for information, and the company can provide an interactive experience on the Web or via links to the Web or phone support services in patient newsletters. These media are still in their infancy, and I would expect to see them blossom in the next five years as traditional marketing managers learn the power of targeted marketing.” Guy Dess is President of Adient and Managing Partner of CommonHealth, Parsippany, N.J., a leading healthcare communications resource and a WPP Group company. For more information, visit commonhealth.com. “Price aside, the trust for the pharmaceutical industry has been affected by the series of letdowns in products that overpromised and, in many cases, underdelivered. The perception of being able to deliver “wonder drugs” was largely created by DTC advertising, but the reality of the product performance made it apparent that the entire product “story” had not always been adequately told; that is, the risks associated with the benefits were too abbreviated. Patients want their pain to go away and not to suffer a heart attack because of it; they want their cholesterol to be lower but not suffer muscle deterioration, and so on. They want to trust that their medicine won’t harm them. And the wonder of pharmaceuticals is that in most cases they work exactly as envisioned. But this isn’t always possible; regaining health always involves weighing risks against potential benefits. But it is extremely difficult to lay out a risk-benefit equation in front of patients and have them grasp the full meaning. So until we can clearly convey the fact that medicines, in one way or another, alter basic physiologic functions and therefore do good at a cost — and that sometimes this cost is significant — trust, of both medicines and the companies that manufacture them, will continue to be an issue. The key to less visible but highly efficient and effective consumer communications is to establish one-to-one relationships with customers. TV is not only expensive, it can also be wasteful. Because even with good demographic targeting, there is the cost of paying to reach so many people who are not in the target audience. By using media that allow for two-way communication, consumers not only give marketers permission to send them tailored information, but they ask for it. Customer relationship marketing may not only mitigate the need for big TV budgets, it also offers a chance to get patients more informed, more educated, and more actively involved in their own healthcare. TV is great for communicating a broad message, but deeper reinforcement requires other channels. The challenge is to move consumers and patients to participate and adopt these channels, and to do that, marketers may also need to enrich their experience with more than just information.” Robert Nauman is Principal of BioPharma Advisors Network, Cary, N.C., which is a community of consultants who interact on engagements, routinely share ideas, and maximize cost benefits for clients. For more information, visit biopharmaadvisors.net. “Pharma’s reputation has been seriously injured, maybe even mortally. One only has to look at how the jury award in the Vioxx trial was determined to understand that there is no trust left in the bank accounts of the various pharmaceutical manufacturers with the American public. I can point to positive examples that would refute this claim; but in the end the industry now is being judged on perception, and that perception is that pharmaceutical companies care about their customers after their profits. Even the major investment analysts suggest it will be some time before the industry can expect to realize growth because of previous business practices. If the industry is going to shift paradigms, now would be a great time. Actions speak louder than words. The industry needs to find out what the consumer, patient, and caregiver want and deliver it without compromise. TV does not allow for the interactive communication that is critical for successful healthcare outcomes. A combination of channels, such as nurse phone support followed by a live chat session online, or referring patients to a particular part of the Website where that information lies, are some good examples. Others include direct mail, followed by access to an online Website that has personalized content. A single, uncoordinated-channel approach to communicating with the public is no longer viable. We need to understand who these customers are and how they want to be involved with their medication regimens.” Terry Nugent is VP of Marketing at Medical Marketing Service Inc., Wood Dale, Ill., which is a supplier of lists and direct-marketing services to the pharmaceutical marketing and continuing medical education community, the original American Medical Association (AMA) Database Licensee, and an Alliance for Continuing Medical Education value vendor. For more information, visit mmslists.com. “It appears that the PhRMA guidelines are softer than some in Congress would like. I suspect government regulation will result. There are two main vehicles companies can turn to instead of DTC. Direct marketing is an ideal way to efficiently, effectively, and discreetly communicate with consumers. Direct mail and e-mail are the optimal tactics. Lists of ailment sufferers are available, and potential sufferers can also be targeted in various ways, for example demographically, by age, or by gender. The Web is another vehicle to use. Banner ads, as well as paid and natural searches, are cost-effective ways to reach consumers who are searching for information about diseases and conditions. ” Editor’s Note: Please see PharmaVOICE’s VIEW on Marketing later this month for more thought-leader insight on the state of DTC, as well as the results of our reader survey on this topic. Eric Dezenhall Dezenhall Resources The challenge, in part, is getting the industry to spend a lot of money to communicate positive messages to the public with the understanding that there will never be a day when it will be self-evident that there is a measurable return. Ken Johnson PhRMA The patient is at the core of everything the industry does. So if the common public perception is otherwise, we have to make some real changes in what we do and how we do it. PharmaVOICE Reader Survey Tackling the Challenges PharmaVOICE asked its readers: Do you believe that all the different sides of the industry can come together and move beyond competitive issues to resolve the trust challenge? Response Strongly believe 15.7% Do believe 51.4% Do not believe 29.2% Strongly do not believe 3.7%Other PharmaVOICE asked its readers: Is the current public-perception crisis because the public does not understand the drug-development process? Response Yes 66.5% No 33.5% Source: PharmaVOICE, Titusville, N.J. For more information, visit pharmavoice.com. Note: The 243 respondents to these questions include the following types of companies: 25.1% pharmaceutical, 23.9% marketing/communications supplier, 7.8% biotechnology, 7.8% contract research, 7% service, 4.5% information technology, 3.3% biopharmaceutical/biology, 2.5% device/diagnostics, 1.6% drug development/clinical-trials consulting, 1.6% media, and 14.9% other. Lynn O’Connor Vos Grey Healthcare Group Bridging the communication from doctor to patient is the opportunity available to us right now. If we do that well, we provide a great benefit for the patients, and we will improve relationships with physicians again. Dan Grimm BD If the industry doesn’t do anything to define itself, this indirectly gives permission to allow someone else to define the industry, which may not be accurate or preferred.

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