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MARTY'S MEDICAL MUSINGS
In Joseph Heller’s legendary ‘70’s novel Catch 22, archetypal free profiteer Milo Minderbinder is astounded that the novel’s protagonist Yossarian is granted “all the dried fruit he wants” as part of his recovery from war trauma.
Milo is incredulous as he reads the prescription that Doc Daneeka has written. Milo is driven by market efficiencies and the prospect of a fair profit for all. So his head spins at such an open prescription. “All the dried fruit you want?” he says to Yossarian. “You don’t even have to eat it. Or need it”.
All the talk of price signals, health system efficiencies and co-payments related to the Federal Budget took me back to Milo’s credo that prices act to drive efficiencies.
I’m an old public health guy whose dad was a union shop steward from the north of England. So I was raised to understand the importance of welfare and publicly funded health services.
But making something free won’t guarantee it is delivered efficiently or that those resources will be allocated only to those who genuinely need them.
So I’ve come to appreciate the role of “market forces” in the health system. For example, who has an immediate, driven, tangible incentive to keep Australians out of hospital? The government? Not really, because any long-sighted investment in disease prevention will only deliver a tangible return for future governments.
The people who have the greatest to gain from keeping people out of hospital are those who under-write much of the costs. That is, the private health insurance funds.
So why not let them incentivise GPs to do more preventive work and disease management? Why not let them offer lower premiums to members who lose weight or stop smoking?
They can’t do either of these things because current health policy does not allow it.
As for the co-payment on GP visits – it’s clearly a mechanism for driving efficiency. It is there to maximise the prospect of the service being necessary for the person who is seeking it.
And yes, to all you Catch 22 aficionados, I know Milo ended up bombing his own squadron to make a profit via a contract with the enemy.
But on the risks associated with prescriptions that let patients take as much as they want for free without having to demonstrate a need or pay a price – I think he was ahead of his time.
Martin Palin, Managing Director
Many years ago I had a letter published in one of the marketing magazines in response to an article about a multi-national pharmaceutical company that had awarded its entire diversified marketing budget to one global holding company on the promise of greater integration.
I said in the letter that I couldn’t see the logic because the market place knows that talented people work for a range of different agencies of varying sizes for a heap of different reasons. There’s just no logic in believing that one holding company will have either a local or global monopoly on all the brightest people across PR, media strategy, advertising creative, content marketing and market research.
Plus I reckoned the people from the different teams under the umbrella of the holding company were likely beavering away in their own silos and had probably never even met each other.
My view still holds and was also recently verified (certainly at the level of the individual PR agency) over a cup of coffee with a colleague from the public affairs department of big pharmaceutical company.
He had just overseen the process by which his company had settled on a panel of “preferred specialist PR agencies”. So preferred in fact that the marketing team was prevented from commissioning any PR agencies or any PR work from consultancies outside the list. No correspondence entered into.
The company had developed a set of criteria built around capacity, experience, value for money, terms of business, hourly rates and a raft of other quality measures. His job was to scour the market and secure the best possible PR agencies for his restricted panel. And guess what?
Every agency selected was independent, medium sized and still owned by the principal. Every selected agency.
It’s more than just the arithmetic. Most clients can work out that while a multinational PR agency might have 30 consultants in total, only 5 or 6 of those typically (if they are going well) will be exclusively in the healthcare team. So their teams are the same size as the well-established independent specialist health PR agencies (like Palin Communications and our independent competitors).
The preference for independent agencies is underpinned by the demand for commitment, longevity and experience.
Clients that examine the relative benefits of independent versus big multi-national agencies see the value in having an agency with the key guy’s name on the door. They know that the quality of the agency’s work is the only thing standing between the principal being out of business and the staff being unemployed. So it’s unlikely the team will be cutting too many corners or disappearing any time soon.
So the next time the question of “global agency versus specialist independent” comes up, think about the capacity, experience and commitment of the relative teams. Avoid getting distracted by nonsense about “global footprints” and “international integration”. Because it is capacity, experience and commitment that is going to get you the best PR result.
So think independent.
The Palin team. Proudly independent and specialised.
I happily entered into the spirit of things as part of a panel at the recent “Festival of Ideas” session on “Medicalising Normality”
Industry critic Ray Moynihan was holding court and we had engaged the audience in the creation of a new disease – “Chronic Procrastination Syndrome” – or CPS we called it.
After 20 minutes we had a set of symptoms (constantly putting things off, a life dictated by delay), a screening tool (how long did it take you to agree to see the doctor, how long do you linger over a menu? etc) and an estimate of the overall cost to the community of CPS in terms of lost productivity and unmet ambition (clearly in the billions annually).
We had a slogan (“Act Now: CPS is real”), a celebrity ambassador and a date for an awareness day – but we decided to delay that by one week for strategic impact.
We were having a hoot and the audience were getting the hang of it. I was a bit worried they might think this is what actually happens. But at least they were getting a sense of how health campaigns get coordinated if not how diseases actually get defined.
Sometime earlier the panel had focused on a more practical debate about the relevance of prescribing data and prevalence figures in trying to determine whether or not ADHD was over diagnosed in Australia. (I thought it highly relevant others not so).
These were no academic or philosophical debates. The reality of them was highlighted the next day on Saturday October 6th when the Fairfax headline screamed “Suicide link to ADHD drug” – thereby triggering a broader media storm about the appropriateness of current prescribing levels.
I tweeted that this was exactly the kind of debate we had had at the Festival of Ideas.
Then on Sunday 7 October, it was bi-polar in the news when the News Ltd papers quoted a psychiatrist as saying the definition of bi-polar was so broad than almost anyone could now be diagnosed with it.
The definition of disease is no easy task. But I think there was at least one thing on which all the panellists at the Festival of Ideas agreed. It was that some people and some families are seriously affected by conditions like depression, bi-polar and ADHD. It would be tragic if their battles were made harder because debates about disease mongering and over-diagnosis trivialised the reality of those diseases and the challenges faced by those affected.
Or as a lady with ADHD said in her letter to the Herald in response to the original story, perhaps we should stop seeing “ADHD medication as creating a generation of zombies” we should focus on those people who are helped by it and see it as representing an “advance in medical science (SMH Letters 7/10/13).
I think those from the “over-diagnosis” school need to be specific in arguing for resources to be focused on those people who need them the most – ie, those who are at the more serious end of various conditions. Otherwise it just turns into disease denial and I can’t see how that is going to help anyone.
Unless of course that disease is Chronic Procrastination Syndrome in which case a little light-hearted fun and a lack of urgency to make a point are probably going to be ok.
Martin presents at the Festival of Ideas “In defence of disease awareness”.
At the end of the case study I invited questions and the Marketing Director asked “Is that it? Is that all you’ve got? Patch sales went up on World No Tobacco Day? Doesn’t that happen every year?”
Well yes and no actually.
It is related to the broader question that (probably out of politeness) doesn’t get asked as much as you would think. That question is: “Does healthcare PR actually work?”
The answer to that question is “Sometimes, but it depends”
It depends on your aims, your plan and what you measure.
In many ways a more interesting question is “How can you show that it works?’
You can show it works by establishing agreed quantitative targets (ie. media coverage, audience engagement*, increases in consumer knowledge, traffic to your website, shares of content etc) ahead of time and then hitting them. *Note that engagement is a loaded word and must be more clearly defined based on the objectives of your campaign.
People who get proposals from the Palin team are used to seeing a section on “Quantitative targets” over which we can haggle.
There is another important step which involves developing business-related performance indicators for PR in consultation with the client. What opportunities are there to integrate fields related to PR into the “How did you hear about this?” questionnaire for the telephone sales team? What benchmarks related to consumer awareness are available via the regular community surveys that the clients conducts?
The challenge is to find measures that have commercial relevance for the client and are tied to broader initiatives that track business outcomes.
If you adopt this approach it barely needs saying that “Advertising Value Equivalents” (How much would it have cost to buy an ad equivalent to the space our editorial recieved?) and arbitrary measures of media sentiment (wow we scored a positive 4.2 in 2012, yeehaw!) no longer become central to your evaluation program.
Which, we are happy to say, is all in line with the latest evaluation guidelines endorsed by the Public Relations Institute of Australia (see The PR Professional’s Definitive Guide to Measurement).
In regard to the nicotine patch presentation, clearly I jumped too quickly to the sales data and didn’t spend enough time explaining how the PR had driven enquiries to their “Help Line” and how some pretty ambitious media relations targets (like celebrity quitters on Today Tonight and positive national TV news stories) had pretty much been smashed.
Evaluation is a subject that is close to my heart because I came to PR from a background in social research.
When I first started in healthcare PR I could see that evaluation and measurement was a huge issue. I was young and cocky and thought I could fix it in about three months.
As you can imagine, it’s more complicated than I thought but the principles are pretty straight forward. Build performance indicators that mean something to your clients, establish realistic benchmarks, develop strategies with those targets in mind, and measure and refine the strategy as you go.
Above all, be accountable.
That’s what we’re determined to be at Palin.
Accountable consultants with clear definitions of success that have been agreed and tailored in partnership with our clients.
Because if we can’t agree what success looks like how will we know whether to laugh or cry when the campaign is over?