By Mark Chataway
“It’s Déjà vu all over again,” as a great American thinker once said. I talk to clients about communications with end users and it sounds just like 1985, when I started working as a communications consultant to the industry. Back then, there used to be a whole series of excuses for not doing media relations programmes about prescription medicines. “It’s illegal”, “it costs too much” and “it will upset doctors” were top of the list. As a result, lots of good medicines were ignored by doctors and patients alike. In 2002, standard public relations has an assured place in every marketing programme but the excuses live on if a consultant strays from suggesting a series of press releases and journalist freebies. From my European viewpoint, our industry is committed to scientific innovation but terrified of it in marketing and communications.
The industry knows it has to deal with patients and their families in Europe – its end customers – but it has a well-rehearsed list of tired reasons why it can’t or won’t right now. The latest is that the EU is about to change the rules on DTC communications so we should wait to see what happens.
The truth is that the changes proposed are modest, will not happen soon and may never happen. But European regulations allow lots of DTC communication now – some of it more permissive than would be allowed in the USA. Let’s look at the most common excuses for not going on with it.
“It’s illegal”. Companies are free to do anything fair, balanced and reasonable to promote treatment of a disease. They cannot induce prescription of a specific agent but there is nothing on our bit of the earth to stop them promoting an informed dialogue with doctors about treatment options (which would, for example, be a big help to most patients with psychiatric disorders in Europe who get dangerous, cheap, old medicines rather than safer, effective, new ones). They can fund, legitimate, academic institutions or patient groups to provide specific information about specific treatments (based on specific trials if they want to highlight the implications of new findings). Companies can direct patients towards this information. Yes, branded 30 second spots are illegal but DTC communication is not. And 30 second spots on mass market TV channels just do not make economic sense for most medicines, anyway.
“It’s too expensive”. If we worked for Unilever and admitted that we lost half of the customers we acquired – and had acquired at vast expense – within six months, we would be fired. Yet, the pharma industry accepts this as a fact of life. Interactive adherence and compliance programmes are amazing value — using adapted CRM technology it costs pennies per user. How many pharma companies do them? Well, a few have quite sophisticated programmes (Schering AG in multiple sclerosis, for example) but I have searched in vain for anything in depression, osteoporosis, cardiovascular health, fertility or any of the other therapeutic areas that touch millions of lives.
“Our consumers only use conventional media and that rules out most of what you’re talking about”. This may look true to people in the US using old data. But Europeans use interactive systems that just do not exist in the US and use the Internet more every day. First, European mobile phones are much smarter: over 1.8 billion (1,800,000,000) SMS – short text messages to mobile phones – were sent in Germany in December alone. (Yes, you should be thoroughly ashamed if you don’t know what I’m talking about). Even the national blood service in the UK uses them to remind blood donors about their appointments. And new generation broadband mobiles are about a year away — the test system is sort of working in the Isle of Man. Our office in Italy is doing a trial measuring the impact of SMS reminders on cardiovascular outcomes but, as far as I know, they are the first.
Second, Europeans talk to their TVs. Terrestrial TV transmitters will be turned off in Europe in about five years time (our governments have already sold the frequencies to other industries so there is no going back) which means that everyone will have to use digital TV. Digital TV is inherently interactive. Over 8 million subscribers in Britain already have interactive TV – what’s more they are older and less well-educated (and therefore sicker) than the population as a whole by all accounts. Every major British bank already offers on-line banking. My mum uses it to check on the racing results. And how many pharma companies are there? Not one (although we are arranging an explanatory event with a TV company for some of the bolder managers).
Third, Internet users are, on average, getting much older and much more likely to wear flowery frocks than flip flops. In some countries, it has almost reached gender parity. In most, the average age for Internet users is 30+. In Finland, over half of the population are active Internet users. Most Europeans on the Net ask about health – some for themselves and many because they are worried about the care their parents are getting. And where is the pharma industry? Well, look at the top 3 companies in cholesterol lowering. MSD (one of the better companies overall) does not actually mention treatment in its non-US homepage on heart disease. BMS seems to have nothing to say about heart disease in, for example, French (the only language of about 50 million Europeans). Pfizer in the Netherlands (or anywhere else I checked) does not even mention heart disease (although their “dealing with depression” site has a long section on diet and lifestyle, a few suggestions that you might follow whatever advice your doctor gives on medicine and then a long paragraph on the benefits of electric shock therapy).
It’s time to take the plunge. DTC communication is not just legal and cost-effective. It’s immoral not to do it. The man who lives across the street from me – a lovely fellow with a very worried wife, both of them extremely active in our community — has had one stroke. He has a cholesterol level of 7.6 (about 300 on the US scale — the one all the American websites use and the one that none of us understand). His last blood pressure reading was 200/100. The British Heart Foundation’s slick Website says, “There are various sets of guidelines to help doctors decide whether to recommend you to take cholesterol-lowering drugs” but thoughtfully does not actually provide patient access to any of the guidelines. All of them are apparently unknown to his GP (cardiologists in Britain rarely venture out of hospitals) who prescribed regular walks and “a bit less butter and beer”. This is good for this year’s drugs budget but very bad for my neighbour and disastrous for long-term care costs. We all know that even radical lifestyle change will, for him, bring marginal benefits. We know too that there are medicines which could dramatically reduce the chance that he will be left a dribbling imbecile for the rest of his life. But we have decided not to tell him about them — in the name of “ethical promotion”. Do you want to explain it to his wife?