 Since the proposals to lift restrictions on the dissemination of information
by the pharmaceutical industry on prescription-only medicines used to treat
diseases such as asthma and diabetes were rejected by the European Parliament
in 2002, it might seem that everything has gone quiet on the patient marketing
front. Not so. Last week, marketing, product, communications and public
relations managers from the pharmaceutical industry assembled at a patient
marketing and communications forum held at the Marriott Hotel, Heathrow,
to discuss communicating with patients and consumers.
The pharmaceutical industry has had to find alternative methods to communicate
with the general public. One way of doing this is to create disease awareness
campaigns (DACs). Current legislation allows the industry to talk to consumers
as long as companies do not promote their products. Moreover, promoting
awareness or educating the public on a particular condition or disease
is
encouraged by the Medicines and Healthcare products Regulatory Agency,
responsible for enforcing the relevant Medicines (Advertising) Regulations
and the Medicines (Monitoring of Advertising) Regulations 1994.
It would be naive to think that the industry promotes disease awareness
solely to
provide a public service — “return on investment” is
a term that was frequently
mentioned during the forum. Some companies are quite frank about why they
choose to
involve themselves with such campaigns. Speaking at the forum, Margaret
Morgan, head of Pharma communications, UCB Pharma, Belgium, said “We
believe that we benefit from disease awareness campaigns and that our products
are supported by that activity.” She explained that if a company
is in the situation of being first to market with a drug, if it wishes
to sustain a position of market leadership, to differentiate from the competition
or to develop the market in a new class or new condition, these would be
good
reasons for getting involved in a DAC. “That is the commercial logic,” she
said. “Everybody gains [from DACs],” she added.
However, there is a fine line between
providing information and promoting a product, it seems, and several companies
have been criticised for finding ways to circumvent the legislation and
industry codes. For example, last year, GlaxoSmithKline funded 50,000 Mr
Men books telling the story of Mr Sneeze and his allergies. The book also
contained
advice from Allergy UK and two pages
promoted Piriton and Piriteze. In material accompanying the book, parents
were asked to cut out these two pages before giving the book to a child,
so as not to contravene
the law prohibiting advertising medicines
to children.1 A spokeswoman from GlaxoSmithKline told The
Journal that
the company had received no complaints about the book. The MHRA did investigate
and the company has responded in accordance to its recommendations, she
said. This year, the book will be reissued but the product information
will be provided in a separate leaflet.
The pharmaceutical industry has been
accused of “disease mongering” — using DACs to “medicalise” normal
conditions, such as male pattern baldness. “A lot of money can be
made from healthy people who believe they are sick,” say the authors
of one article in the BMJ.2 Industry has also been accused of breaking
advertising regulations3 and paying celebrities to endorse products and
popularise illnesses. One biotechnology company has even been
accused of duping celebrities into supporting a campaign to lobby for the
introduction of a particular cervical cancer screening test on the NHS.4
Using a third party to communicate with the public is a popular technique
with
marketeers. For example, getting a “real
patient” account published in a newspaper is an effective way of “making
noise”, according to Ms Morgan. This is because people are more likely
to accept information from a third party rather than from a drug company.
Patient relationship marketing
Some pharmaceutical marketeers believe that DACs are not the only approach
to patient communication. Diane Stafford, head of
patient relationship marketing, Pfizer UK, also speaking at the forum,
said that DACs are useful for bringing forward a visit to the GP (which,
it is hoped, will result in a prescription) but they do little or nothing
to improve compliance.
Motivating a patient to seek treatment can cost anywhere between £5
and £20 but if, after a few months, the patient stops
treatment that is a huge investment loss. The answer, according to Ms Stafford,
lies in looking outside the pharmaceutical industry and paying more attention
to the concept of
customer loyalty. Loyal customers not only repeat purchases, but they spend
more. They cost five times less to keep than acquiring a new customer.
Ideally for marketeers, these customers become advocates and recommend
the company’s products. And that is the
ultimate goal.
Loyalty means engaging the consumer in a relationship. For example, Ms
Stafford said, if a person wants to buy a BMW car, all the necessary information
is readily accessible. Moreover, BMW will build a relationship with that
customer to the extent that it will send him or her service reminders.
Why is it that this cannot be applied to the processes regarding a person’s
health, she asked. What if companies sent out personal health check
reminders?
In the pharmaceutical industry, patient support programmes are an alternative
to DACs. One example is the helpline launched last year, by Roche in collaboration
with International SOS, to support patients
prescribed orlistat. By telephoning a freephone number and reading out
the serial number on packaging, a patient can register with the programme,
which offers advice and
encouragement from a team of nurses and nutritionists. This kind of activity
could help with compliance and the programme organisers claim that the
average duration of
treatment for registered patients has doubled. Other programmes might nurture
relationships through sending questionnaires, information and positive
messages to consenting customers. “Its all about creating a positive
experience that makes [people] want to
engage with us and use our products again,” Ms Stafford said.
Whether or not these kinds of activity are within the legislation appears
to be a grey area and open to interpretation. According to Richard Ley,
head of media relations, Association of the British Pharmaceutical Industry,
each case would have to be looked at upon its merits and, providing the
existing rules are adhered to, this sort of activity could prove useful
to doctors, patients and the industry.
However, the Consumers’ Association is worried that such services
could prolong a treatment when it is not appropriate.
Ms Stafford emphasises that building
relationships with patients does not necessarily mean talking to a named
patient about his or her particular condition. It could mean addressing
smaller groups of consumers with the same needs, for example, people who
have had a heart attack and have raised
cholesterol levels. “Key within the [ABPI] code is that we must not
get in the way of the doctor-patient relationship but programmes could
help patients use their time with GPs effectively, for example, in phrasing
difficult questions they might want to ask,” she said. Corporate brand building
Pharmaceutical companies are also
concerned about image. “We make medicines that save lives, but we
are regarded with the same contempt as the tobacco industry. How are we
going to reverse this trend,” asked Ms Stafford. Another strategy
is to build long term relationships with patients on a
corporate rather than on a disease level. Pfizer US has already done this
with www.pfizerforliving.com,
a website that targets health information at people over 50 years old
with cardiovascular disease and
other risk factors. People registering with the site are able to use
its resources and interactive “health tools”. This system also
allows customised health awareness information to be sent out. For
example, if a user has diabetes, he or she can be sent information about
hypertension. Even though DTCA is allowed in the US, this site does not
focus on Pfizer products. And the company says that this approach works.
It
improved attitudes about pharmaceutical companies as well as persistency
for Pfizer medicines.
A further strategy is to get involved in
corporate sponsorship of public events and exhibitions. For example,
GlaxoSmithKline is sponsoring the El Greco exhibition at the National
Gallery. This might
seem odd
because the NHS does not let people specify which brand of medicine they
want. However, corporate brand building can be worthwhile, Colin Wheeler,
senior lecturer in international marketing at Strathclyde University,
told The Journal. “Many companies have a vision of where they want to
go and how they will get there. Those that are highly organised will choose
to sponsor events likely to be visited by specific audiences,” he
said. For example, Mr Wheeler explained, by sponsoring a particular event,
the company might be seeking to influence opinion formers, such as doctors,
academics and civil servants, rather than targeting the general public.
Indeed, the websites of many museums and galleries reveal that these
institutions sell corporate sponsorship by claiming benefits that include
public recognition,
opportunities to reach government, community and
business leaders and enhanced shareholder and customer relations. Information age
In a climate of patient empowerment, few would argue against people having
access to accurate information about diseases and
available treatments. The issues are not around whether patients should
be given information, but who should give it to them. Industry argues that
it is best placed to do this because it has all the information that is
available about its products. But, according to the Consumers’ Association,
there is a conflict of interest when the information is provided by drug
companies.
There is also the concern that if making information available is left
to the pharmaceutical industry, there would be no information on less profitable
disease areas. The Consumers’ Association says that it is essential
that consumers have access to one central and independent portal for health
information, including medicines and treatments, particularly with the
wealth of unreliable information available on the internet. NHS Direct
is on the way to meeting this need. The Consumers’ Association says
that government is a preferable source of information but,
ideally, the source should be free of political interest. One suggestion
is that instead of
investing in DACs, the pharmaceutical industry could contribute funds towards
such an independent information body.
Perhaps pharmacists should ask themselves what role they ought to be playing
in
promoting disease awareness and giving
information about treatments. References
1. Meikle J, Tryhorn C. Book for children markets firm’s
drugs.The Guardian 2003 Aug 12.
2. Moynihan R, Heath I, Henry D. Selling sickness: the pharmaceutical
industry and disease mongering. BMJ 2002;324:886–91.
3. Drug and Therapeutics Bulletin. Withdrawal of pimecrolimus advert.
Available here
(accessed on 17 May 2004)
4. Barnett A. Revealed: how stars were hijacked to boost health company’s
profits. The Observer 2004 Jan 25. |
The
Pharmaceutical Journal