Healthcare PR Insights

Welcome to the new age of big pharma transparency

Fri, 04 May 2012 06:58:00 GMT

Has the environment changed for medical marketing in Australia? You bet it has.

Fifteen years ago Ray Moynihan was developing his feature series for the Financial Review on pharmaceutical company transparency. I remember he asked me then whether I thought any of the kerfuffle being triggered by he and other journalists (like Melissa Sweet who was then Health Editor at the Sydney Morning Herald) would lead to any tangible change in the way pharmaceutical companies operated in the future.

I just told him the truth and said I had no idea.

No one could possibly have predicted then the extraordinary changes that have happened since.

To get the full picture, you need to understand something about what was happening in medical education around the world in the mid 90's. Corporate sponsorship of medical meetings, continuing education and consultancy work was growing exponentially in a largely unregulated environment.

In fact it's only really in the last few years that regulations have changed in Australia requiring companies to disclose the amount of money invested in educational events. And the much discussed Physicians Payments Sunshine Act in the USA, which has effectively legislated increased levels of transparency there was passed only five years ago in 2007.

Interestingly, in further good news for international advocate groups on this issue, there are reports now that Obama's healthcare reforms will include provisions for each and every individual transaction between a healthcare professionals and a commercial sponsor (including speaker fees, conference costs, travel, consultancies, advisory board work) to be posted via a publicly accessible website. In the USA, this could happen as early as September next year.

But where and how did it all start?

One development that gave the issue broader traction was the publication in 1998 of Ray Moynihan's book "Too Much Medicine". Its parallel themes of company-sponsored "disease mongering" and "bought influence" were played out brilliantly in well orchestrated PR launch for the book.

This was followed soon after by perhaps the most infamous episode in the natural history of this issue in Australia. It was the Channel Nine Sunday expose which used a hidden camera to film a sponsored meeting of specialists in Sydney. Unfortunately for the industry, the expose featured dancing girls and apparently inebriated delegates. It triggered a raft of additional stories many of which made reference to said dancing girls.

This TV story in some ways acted as the local catalyst in putting pharmaceutical transparency on to the health issues map in Australia.

But all of that is quite a contrast when you consider where we are now.

These days pharmaceutical companies themselves are among the most vocal advocates for increased transparency. Some argue that the industry should get out of medical education sponsorship entirely while others advocating for disclosure of payments to doctors on an individual basis.

Now the position of the companies is about increasing transparency to improve the industry's reputation. Senior pharmaceutical executives blog about it and corporate affairs heads appear on national public affairs programs to argue for it.

Not that all companies in Australia agree on the need for changes. Some have argued that the current system is working well and there are no obvious reasons to change it.

Regardless, the next version of the MA code looks set to make provisions for members to implement increased transparency in its dealings with healthcare professionals.

But it's no straight forward issue. One difficulty is that the various commentaries tend to tangle up a whole range of issues related to pharmaceutical company activities that involve healthcare professionals. For example, the Greens are on the record as saying there should be no pharmaceutical company sponsorship of continuing professional education for doctors at all. But that doesn't really say anything about the more subtle relationships that revolve around consultancies, advisory board work or sponsorships of conferences.

So not everyone in the debate is always criticising or defending exactly the same thing.

Issues of complexity and historical context aside, what does an increasing focus on transparency mean for those of us in healthcare PR, stakeholder management, medical education or pharmaceutical marketing?

First, we need to understand that transparency is now a guiding principle in establishing how medical marketing and healthcare PR gets done. If it is true (as I often say) that good medical PR is driven by what other people say about your brands and issues, then any competing interest relevant to what is actually being said by others , needs to be made abundantly clear.

Second, adjust your policies and guidelines (whether for agencies or companies) to line up with the new environment. If you don't have policies or guidelines then now would be a good time to start developing them.

Third, make sure the opinion leaders and specialists with whom you work understand the new environment. Most of them do not deal regularly with the risks associated with pharmaceutical sponsorships and only a few will have had negative experiences. No-one wants to compromise a relationship or stuff up a campaign by attracting attention to its lack of transparency.

Fourth, read and follow. It is fluid, evolving and there is a lot going on. For example, much of what is discussed above (the advocacy for increased disclosures by pharmaceutical companies, the statement by the Greens, public discussions about implications for the MA Code) plus a statement by the International Federation of Pharmaceutical Manufacturers that they were updating their guidelines to increase transparency, all happened in the space of just a few days in late March 2012. And all of this is just the prelude to the new Medicines Australia Code which is set to enshrine new regulations as Australian industry policy.

Fifth, look for opportunities. This issue is really about corporate social responsibility. The responsibility to do the right thing and conduct business in an open and ethical way. If that is consistent with your company ethos and principles then clearly category leadership and compliance can be turned into corporate positives.

So the answer to Mr Moynihan's original question in 1997 about whether all the "kerfuffle" about transparency would likely change anything substantial about the medical marketing game in the future now seems very clear.

It actually looks and feels like a completely different game.

The key question is how well positioned are you to play it? And what communications opportunities might it present you in the future to distinguish yourself from other stakeholders in the marketplace?

See the Palin video blog on this topic here.

Cracking the code to better ethical PR

Fri, 04 May 2012 06:59:00 GMT

The fact that the pharmaceutical sector is one of the most heavily regulated industries in Australia is just one reason why it is important for pharmaceutical marketers – and their agencies – to have a good solid working knowledge of the various marketing codes.

With the 16th Edition of the Medicines Australia Code of Conduct under review, I thought it timely to review the provisions that relate to direct to consumer communications and tease out the implications for PR.

Much is made of the apparent "one bite of the PR cherry" for "a new product, indication or PBS listing" (12.4.1).

I suspect in its original form the provision was intended to cover nothing more than a confirmation in the public domain that a new compound had now been registered for marketing or that its indication had changed significantly (ie, it was now approved for use in an area that it had not previously been used in). No doubt these announcements were occasionally leveraged into more substantial news opportunities.

In recent years this provision has been misinterpreted by some as representing an opportunity for a promotional free-for-all. But there are strict provisions in the code about how this media relations process should be managed. The over-arching guidance is that any promotion to the general public "must be educational" (12.3) "and not include promotional statements or claims" (12.4.1).

Some people question why different versions of the media release are often prepared for healthcare professional and consumer media. Part of the reason is that there are some important differences between what can be included in your healthcare professional media release and what can be used in the consumer release. For example, your consumer media release must not include "quotes from experts, opinion leaders or patients that are promotional" (12.4.1) whereas this provision is more lenient when healthcare professionals are the target audience.

What if you decide to restrict your media releases and communications program to healthcare professional media only, but the process of implementing that program attracts the attention of a consumer news journalist?

Well surely the independent actions of the journalist are a matter for them and not covered by the code?

Interestingly the Medicines Australia complaints committee recently found a breach of the Code had occurred exactly along these lines – because the member and its agencies had not done enough to ensure that a consumer story (originally triggered by some healthcare professional PR activity) was accurate and balanced. They ruled a breach had been committed even though they accepted the manufacturer and its PR agency had not proactively attempted to promote the story to consumer news outlets.

The Complaints Committee ruled that the company knew a consumer journalist was interested in reporting on their development and the Committee therefore believed the company had "made no attempt to prevent the [consumer coverage] occurring".

So the onus is very much on the manufacturer and its agencies to keep the implementation of the healthcare professional and consumer streams quite separate.

In my experience the main areas of internal conflict (usually between the medical/regulatory team on the one hand and the marketing/corporate affairs team on the other) are around (1) the interpretation of "promotional" and (2) in relation to pack shots for consumer media.

First the issue of promotions. Of course one man's promotion is sometimes another man's education program. But let's not forget that the media release is actually about what (we all presume) the company and the regulators think is a positive development. Aren't we trying to educate people on the benefits?

Second, the code is clear in its position on pack shots ("media release must not include pack shots..."). But it is "acceptable to respond to media enquiries..." (12.4.2). So where a journalist is trying to distinguish in their story exactly which product they are referring to by showing a visual in it, and have specifically requested that visual, then a manufacturer would be able to argue it is responding to a request in a responsible way as a tactic for minimising the risk of "incorrect information" (12.4.2).

The manufacturers that handle these processes best are the ones that have policies and positions agreed in advance. What does the company regard as promotional? How does the company agree to respond to pack shot requests? What role do we agree external commentators and medical specialists can play in these processes?

Planning for code compliance with prescription-only launches is all part of diligent marketing and effective PR.

Because companies who continue to see the "one bite of the cherry" provision as a promotional free for all are clearly heading for regulatory trouble.

Can PR help secure public funding?

Mon, 30 Apr 2012 05:07:00 GMT

Good PR can play a key role in changing public policy. There are countless examples, but one primary area of major PR success is in tobacco control, where groups with modest advertising resources like Action on Smoking and Health (ASH), the Cancer Council and various state-based advocates have won comprehensive victories by driving a constant barrage of editorial stories about the risks of second hand smoke and the public health benefits of tighter controls.

But what about at a more micro level? Say at the level of the level of the individual not-for-profit organisation? Or more commercially at the level of an individual pharmaceutical compound?

Consider the Shepherd Centre in Sydney as an interesting example. It is a leading provider of clinical and educational services for hearing impaired children from the ACT and NSW.

By early 2010 it was facing some significant threats to its public funding.

The NSW government was already providing the lowest proportion of overall funding (only 20 per cent of the funding required to run The Shepherd Centre) compared to the contributions of state governments in other states (all other states provided approximately 40-50 per cent of funding support for their state-based early intervention services for hearing impaired children). In the ACT, the local government had written to the local Shepherd Centre in 2009 confirming that its funding would not be extended beyond June 2010. At a Federal level, there was no overall 'disability' support mechanism for children diagnosed with hearing impairment as had been implemented for children with conditions like autism. All this was happening at a time when (because of increased new born screening) demand for services was increasing by approximately 30 per cent each year.

On the horizon though were political elections at every level – and these were set to provide a context within which the Shepherd Centre could elevate their lack of public funding as a political issue.

So The Shepherd Centre set about attacking this challenge at three levels.

ACT funding: This began in the ACT in March 2010, with a media relations campaign which aimed to raise awareness about the damaging implications of the decision by the ACT government to cut local funding. This reactive program was supported by seasonal media relations efforts in January 2010 and again in January 2011 which used the "back to school" angle as an opportunity to trigger positive stories in local ACT media about the positive work of the Shepherd Centre and the remarkable results it was generating. The ACT phase was effectively completed with the media relations campaign and media release on Feb 11th 2011 headed "Shepherd Centre secures ACT government support in Canberra".
NSW funding: The NSW phase began with a media alert to key NSW media targets on February 11th 2011 inviting interviews with the Shepherd Centre CEO. The alert was headed "DID YOU KNOW? That NSW is the only state not adequately funding early intervention services for hearing impaired children?" This generated a series of media stories and 2UE took up the cause, running an extended interview and Channel 10 TV news running an "expose" on the issue. In some cases the relevant Minister contacted the journalists involved directly to seek further clarification. The NSW phase was effectively completed on March 11th 2011 with a media relations program and a series of media interviews triggered by the release on Friday 4th March 2011 headed "Shepherd Centre secures emergency funds from NSW Government". Since this announcement the newly elected NSW government has committed an additional $100,000.
Federal funding: This phase began with representations to the then Parliamentary Secretary on Disabilities (Mr Bill Shorten) about the prospect of co-ordinated Federal Support for families who have children with hearing impairment. At the end of July 2010 (in the lead up to the Federal election) The Shepherd Centre joined with other service providers via the national coalition of organisations – known as First Voice – to congratulate the Labor Party on its commitment to implement such a scheme should be elected at the Federal poll. First Voice spokespeople appeared on ABC TV and other media outlets discussing the merit of the proposal and speaking to its own release about the importance of funding for dedicated centres that provide hearing services to young children. This phase of PR activity effectively ended when the Commonwealth Government confirmed in its budget announcement of May 2011 that it was providing funding of $6,000 dollars per child per year for two years to families with hearing impaired children as part of the "Better Start" initiative.

PR can't take credit for all of the success described above but implementing a program that facilitates political progress is certainly achievable.

And if you do it well it means that good PR ends up funding itself. Because your PR investment is helping to secure additional funding from separate sources.

Anyone who watches TV news and reads the papers will have witnessed numerous recent examples of pressure being brought to bear on political decisions that have delayed improved access to some medicines in Australia. These initiatives are being run because combining a well run lobbying program with a high profile media campaign is an approach that has a long track record of political success in the Australian healthcare sector.

They are doing it because they expect to (eventually) get a return on their PR dollar.

And based on recent experiences in both the private and public sector, who is to say they are wrong?

For more information about how effective PR can help play a role in health-related public funding issues, contact Martin Palin at via email or call him at Palin Communications on 612 9412 2255.

Healthcare PR

Fri, 04 May 2012 07:01:00 GMT

Healthcare PR is about targeted communications with specific audiences on health-related issues to achieve agreed outcomes.

Some people think it is just "PR that targets doctors and pharmacists" which is not true. Of course healthcare professionals are important target audiences in many projects, but the element that defines healthcare PR is not the target audience - rather it is the subject matter.

And the subject matter is always health-related.

So whether it is talking to the readers of Women's Weekly about natural approaches to menopause, or talking to ophthalmologists in professional newsletters about new approaches to eye surgery - it's all healthcare PR.

The following tasks would all be typical healthcare PR tasks, too:

Launching new pharmaceutical products
Switching products from prescription only to OTC availability
Managing a health-related crisis - a product recall, an extortion attempt or an aggressive attack by a tabloid media outlet
Promotion and media relations for a medical conference
Raising the corporate profile of a health-related organisation
Improving relations with peak medical and healthcare groups
Managing medical specialists and opinion leaders

Some examples of this kind of work can be found in our Case Studies section

Seven Top Tips for Healthcare PR

Fri, 04 May 2012 07:01:00 GMT

Like every speciality, healthcare PR has its own little quirks. You can bet that behind every "breakthrough" story on the TV news and every heart wrenching "miracle cure" in the Sunday Telegraph is a health-focused PR consultant who knows how it works.

Clients and peers sometimes ask what we think is the key to successful health-focused PR. The short answer there is no one "key" to healthcare PR. Here are our 7 top tips to healthcare PR.

Personalise the story: There's an adage in healthcare media relations that will always hold true – "No case study, no big story". All big health and medical stories lead with the personal angle; the patient, the success story or the family. You might think it's too hard to get a good case study. That's fine – it just means you think it's too hard to get a big story.
It's not about you: Good healthcare PR is driven by what others say about your products or services and your issues – not by what you say about them. If it's a development in depression, what do the mental health groups think, if it's a cardiovascular story, what will the Heart Foundation say about it. Remember, you're the client and/or manufacturer, so what you think doesn't count for much in the context of a news story.
Tell healthcare professionals first: So Today Tonight is going to feature your big medical breakthrough. What will doctors say when the viewers start asking them questions tomorrow. OMG, did we even tell the doctors?!
It's not about your media release: Don't waste precious time and resources haggling over the copy in the fourth paragraph of the media release. It's about the news package you can pull together around the release – a case study, an expert, some new stats, a breakthrough development, all announced at a major medical conference – not about the words in the media release
A health week or health conference is not a health story: A health week might act as a backdrop for a story – but it is not the story itself. Don't think you can get media to do a story about asthma because it is Asthma Week. PR Consultant: "But it's Asthma Week!" Journalist: "So what?"
Own the research, own the story: Many health-focused stories are underpinned by the release of new research – sometimes about prevalence or otherwise about the success of certain treatments. Make sure it's you that owns, commissions or controls the research – otherwise you're just playing PR catch up with the people who do.
Know the marketing codes: Good marketers know that specific codes for prescription-only medicines and over-the-counter products determine what can (and can't) be done from a PR perspective. For example, some aspects of some codes allow media releases but forbid direct to consumer ads. Part of your job is to understand what is possible and to work with your PR agency to maximise what is legal.

Seven things to ask a PR consultant before you contract them.

Fri, 04 May 2012 07:00:00 GMT

Seven things to ask a PR consultant before you contract them to handle your health-focused PR project.

Do you work exclusively in the healthcare sector? Exclusivity breeds industry knowledge and expertise. In PR it is very difficult to be all things to all sectors. If you have a health-focused brief then you need a consultant that lives and breathes health-focused projects.
Do you have a good understanding of the various codes and restrictions that apply to healthcare marketing and PR in Australia? Code breaches can bring promotional programs unstuck very quickly. Whether it is a natural product being promoted within the rules of the CHC, an over the counter medicine that needs to stay within the ASMI guidelines or a prescription only compound trying to leverage the media relations provisions in the MA code, you need a team that knows its way around.
How well do you know the key health and medical reporters in Australia? News is competitive and this is never more true than in healthcare. This is why you need a consultant who has an ongoing, positive, collegiate relationship with the key editorial decision makers. They need to have the kind of relationship that can lead to a fair and considered hearing of your product or news story.
What examples do you have of successful projects in product launches, medical switches, awareness raising or key opinion leader development? Success in the past is a strong predictor of success in the future. Whatever the focus of your project, you need to feel confident that the team you are about to appoint has handled this kind of project successfully in the past
How do you evaluate outcomes? Will we have quantifiable targets that we are aiming for? If it is worth doing it is worth measuring. PR is no different in this regard. Quantifiable targets helps teams agree in advance what success looks like and what kind of outcomes might constitute a positive return on investment
Will our strategy have extensions into social media, promotions and other tactics – or is it going to revolve around a single media release? Social media can be incredibility influential in healthcare. It can help define, mobilise and unite whole communities of people affected by specific health issues or conditions. If your strategy does not have a proactive social media element then it is probably under-achieving.
Will we have a plan for getting third parties and opinion leaders on board? And what might that plan involve? Good PR is driven by what other people say about your products and issues. Third party advocacy requires time, planning and an understanding of where others stand on your issues and products. If you've got no plan for third parties then you might as well just run a series of advertisements.

Frequently asked questions about Healthcare PR

Fri, 04 May 2012 07:00:00 GMT

How will we measure our success?

There are a number of ways of measuring success in healthcare PR. In most cases they will involve agreeing some quantifiable outcomes before work proceeds.

These outcomes are sometimes related to an agreed level of media interest that needs to be generated ( a certain number of news stories or feature articles on an issue or product) or a specified level of "likes" on Facebook or visits to a website. Whatever targets are agreed, their most important features are that they are measurable, time-limited and related to commercial value.

Can we do it all as news and editorial or will I have to run some ads and promotions?

It depends on so many things – not least of all the nature of your product or story. If you are launching a major new clinical development in a high profile disease area (like heart disease, diabetes or mental health) then your chances of attracting news interest are relatively high. If you are promoting an existing product and have limited third party endorsement then the news value is obviously less. In any case, you should be thinking about a comprehensive strategy that communicates with a range of different target audiences using a range of suitable tactics.

How much media coverage will we get?

Again, there are a number of variables. It depends on the broader context of your product or issue (is it a "hot" medical issue) and the extent to which you are able to build a full package for media. Can you provide a range of case studies to show how extra-ordinary the development is? Can you set up a live demonstration of the surgery or the technology in action? Do you have a range of third parties and credible medical institutions prepared to go public to say how important they think this development is? Once we answer those questions we can come back to look at "how much media coverage you might get"

Do we really need a broader, co-ordinated strategy? Can't we just get our product featured on 'Today Tonight'?

If you've thought about getting your product featured on 'Today Tonight' or 'A Current Affair' as part of a feature story then you are thinking the same thing as about ten thousand other people in the Australian health industry. It is highly competitive. So while this is a tactic that can have a huge impact (and the Palin team has managed a number of stories via these high profile media outlets), it is also highly risky. If the story does not "get a run" then you can be left holding very little benefit for a lot of time and input. Much better to have a comprehensive strategy that engages consumers at a range of levels (social media, promotions, direct marketing, tailored media pitching etc) and helps spread the risk associated with competitive news agendas.

How do we get the media interested in what we are doing?

You get the media interested by knowing what the media need (and don't need). Once you understand the "formula" that different media outlets work to, then the task is to frame an opportunity that fits that formula. It's about compiling a package of information (a news angle, spokespeople, case studies, new research, third party support, photo opportunities, relevant footage, a relevant context) that works for those specific media. Once we know what they need and how they work, then we can work toward getting them interested in our package.

How do we find case studies and personal stories to help underpin our news and announcements?

Case studies and personal stories are very important in healthcare communications and PR. Sometimes they can be sourced via patient foundations and medical charities. Sometimes it is 'word-of-mouth' via medical specialists that are involved in the program or via social media networks. Whatever method is used, major stories will have to include a factual, genuine, compelling, heartfelt case study to give the personal perspective.

How do we negotiate support from opinion leaders or key medical groups and associations for our issues and products?

Remember good PR is not driven by what you say about your products and issues. It is driven by what other people say about them. Including influential third parties in your program is a key way to maximise the prospect of major media traction. Opinion leaders can be involved by you offering to:

brief them on the campaign so they are at least in the loop,
engage them to help develop the communications strategy,
commission them to take on a contracted role as an official spokesperson on the issue or topic or
work together on a research or consultancy project related to the broader issue.

Whichever way these processes are managed, it is crucial that the arrangements:

are transparent,
are negotiated in a spirit of genuine education and
do not seek to dictate a person's professional views.

The fact that we have a common interest or educational objective must underpin our relationships with third parties.

Seven reasons why it makes sense to outsource PR & media relations.

Fri, 04 May 2012 06:59:00 GMT

Seven reasons why it makes sense for Australian healthcare companies and medical not-for-profits (NFP's) to outsource their PR & media relations.

You'll never miss another positive media opportunity – especially those un-answered voicemail messages from journalists that you just haven't quite had time to do justice to in the past
Your investment in media relations and PR will be pre-determined via your agreement with the agency. No more changing the scale and importance or PR day-to-day
You'll have a ready-made team to bounce ideas off for your upcoming fundraising PR, health week or major report launch
You get to take advantage of experience derived from helping a wide range of other not-for-profit organisations (over many years) with their PR
Your reputation with key journalists will improve because you will be presenting a consistent, professional image of your organisation in the media
Your accountability for PR will improve – especially if ongoing monitoring and evaluation against agreed outcomes is incorporated into your agency agreement
Your PR will most likely end up paying for itself as an increased profile leads to better fundraising results and brings pressure to bear for increased government support