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Changing the headlines

Published on 01/02/05 at 11:37am

'You kill people, don't you?' someone said to me when I mentioned my job was in pharma market research. Statements such as this are not uncommon as people often have a biased perception of the pharma industry. Yet, the barrage of criticism directed at the industry is often out of proportion, unbalanced and fuelled by scandal.  

People seem to be interested in two things where the industry is concerned - medical advances or medical tragedies. Writing in the BMJ in 2003 Silvia Bonaccoroso put it succinctly: "When a pharmaceutcial company misbehaves the whole industry instantly becomes the culprit. In contrast, when a doctor misbehaves the whole of medicine isn't condemned."

Good news doesn't sell papers or fire up the public's imagination like bad news. When I worked in the NHS, I knew the standard of treatment was high but rarely did I read a headline which actually focused on the positive aspects of this.

Similarly, we seldom read headlines like: 'Patient given their life back after treatment with new chemotherapy drugs'. Instead, the media tends to focus on drug failures. Even when a pharma company acts in the public's interest, the high profile nature of withdrawing a drug, best-seller or not, is seen as bad coming out of bad.  

Demonising the pharma industry - fact or fiction?

As society becomes more aware of diseases, their prevention and how to combat them, they become more personally medicalised.

A medicalised society will by nature become more disease aware and choice savvy. The resulting consumption means that realistic lifestyle choices will be taken. These are driven by demand as much as production. However, this is seen as the fault of the pharma industry and not as a result of exposure and access to a wide array of information or a choice and cash rich society.

With medicalisation and increased awareness, the public encounter an environment where they want to control their medical fate. Increasingly, patients are asking for particular treatments - traditional or contemporary - aware that they are available for a range of symptoms, life-threatening or not.

The pharma industry is often indicted with creating diseases to captivate public attention. These range from female sexual dysfunction and baldness to the notion that everyone who says to a doctor:  "I am feeling gloomy", is given a pill.

Are people really that easily led and doctors that helpless? Or is our culture of choice extending beyond the traditional confines of physical disease manifestation and treatment?  

The UK is not yet subjected to DTC advertising, which suggests that patients are proactive in seeking out information regarding their health. Either that or doctors are happy to suggest a pharma sponsored illness, following this up with a prescription!

This suggests that physicians, rather than acting as gatekeepers, are the pawns of the pharma industry - an allegation that doctors would reject. If this is the case, it is not the pharma industry which warrants criticism, but a pliable medical profession.

A 2002 article in the BMJ heightens this awareness and transposes choice into disease mongering. It starts off by stating that "Pharmaceutical companies sponsor diseases and promote them to prescribers and consumers" and ends with "we know little of the true extent of these industry funded zones of influence and even less of their influence" - hardly a conclusive debate.  

The article discusses the 'illness' of baldness next to osteoporosis and IBS. Could this be grasping at straws? No matter how the pharma industry promotes itself, it seems it will always be accused of promoting treatments for disease - even baldness. It is a no-win scenario. In another article, the New Standard criticises the pharma industry for buying into the self-help happiness industry - that is, the creation of happiness. It appears that many aspects of our lives are tied to the pharma industry, including 'happiness' which became a commodity in the 1980s sold through health food shops as a pill or infusion.

Whose responsibility?

The pharma industry treads a difficult tightrope. Treating patients always brings with it an emotional tie - our friends and relatives' lives are irreplaceable if a treatment fails. The emotive aspect of human treatment and cure sets the industry apart from other sectors.  

I believe that the basis for the negative image does not come from the industry as a whole but from a range of different sources.

No industry is immune from the negative press that can surround a company and their actions. In this respect the pharma industry should not be surprised at being targeted.

However, this paradigm of corporate blame mongering - fed by the media, anti-pharma groups and a taciturn pharma industry is becoming increasingly entrenched in British ideology, and the pharma industry seems to suffer more than most.

Of course, it is naive to think that the media and anti-pharma groups are going to suddenly start positively endorsing pharma companies. Ultimately, the pharma industry must play a more proactive role counteracting negative preconceptions independently. Bodies such as the ABPI are well versed and ideally placed to address such issues.

Is it just about profit?

In part, the pharma industry is attempting to address this imbalance. One major move is presenting the soft side of the industry by promoting commitment to disease states and social responsibility.  

The UK pharma industry is well aware of its social role, which is played out within the NHS. The industry's commitment to government regulation is evident through the Pharmaceutical Price Regulation Scheme, and through the efforts of organisations like the ABPI to ensure the scheme is redrafted in a fair and balanced way.  

The government is keen to involve the pharma industry in medicines management and partnership roles, although the DH is shy about publicising this partnership.

Discussing the pharma industry health minister John Hutton said: "[They] are the engines of progress in healthcare not the enemies of it. Fair and reasonable profits need to be made to encourage investment in research and development, because without this, our own healthcare systems will be unable to offer the level of service to which we should aspire."

If only this opinion was the norm, particularly as the pharma industry is increasingly working alongside independent bodies, indicating that it is open to new working patterns.  

Good news that goes unheard

The independence of organisations such as the NHS Alliance goes a long way to address the negative perceptions of the industry. The strong lead of the NHS Alliance proves that the industry is a welcome partner in the distribution of healthcare and goes beyond the confines of drug discovery, manufacture and sales.

The pharma industry needs to maintain a balance between self-promotion and fostering a receptive environment. Bodies such as the King's Fund present constructive criticism and recommendations for the pharma industry, stating, for example, in their discussion paper Getting the Right Medicines (2003), that the industry direct more resources "into neglected areas of research and development where there is potentially high benefit". We should listen and act.

Since New Labour came to power the NHS has seen its organisational structure change with the devolution of power to primary care. The pharma  industry has responded by realigning itself, ensuring a symbiosis with the primary care system exists to a greater extent than ever before.

This often happens behind closed doors, with patients largely unaware of the assistance provided by the industry to PCTs. In many cases the industry provides unique and unparalleled resources to PCTs, allowing resources to be directed towards patient care. This low-key partnership approach has benefited patients, healthcare professionals and the industry itself although I suspect return on investment for the industry is not immediately obvious.

Market research among doctors continually reveals comments such as 'this is the usual marketing ploy by the pharma industry' or 'they are just trying to increase sales'. Nevertheless, we should remember that doctors are clamouring for new therapies to improve treatment and compliance, something that is high on the industry's agenda.

Physicians regularly cite the pharma industry as providers of information on new and current therapies, often the main source of physician education in particular therapy areas. This extends out of the consulting room to the public.

Although the main beneficiary, it is not just healthcare that benefits - the economy as a whole grows due to the pharma industry. The industry not only provides the medicines to treat, but also jobs, investment and trade. It also ensures that satellite industries associated with pharmaceuticals continue to thrive and contribute to the UK economy. The pharma industry employs around 70,000 people, not to mention another 250,000 in related sectors.  

The pharma industry is not a stand-alone industry and is heavily regulated in the UK and Europe. The UK government realises that it makes a considerable contribution to the economy and the health of the nation. Furthermore, the government ensures that the NHS is supplied with pharmaceutical products at reasonable prices through legislation like the re-worked 2005 Pharmaceutical Price Regulation Scheme (PPRS) that ultimately ensures that both parties benefit.  

The new PPRS addresses concerns about pharma industry and policy ties, resulting in a new and transparent scheme, revealing an industry that is responsive to the demands of the day. Furthermore, regulation of medicines via the MHRA will probably become even more transparent, due  to the public's demand for greater openness, recent negative press, and policy relationships.

Changing negative perceptions

It is time for further realignment. This must come initially from the pharma industry, backed up by the rarely heard views of the NHS and pharmaceutical partnerships.  This article is not meant to gloss over cracks that appear from time to time in all multinational companies. However, there needs to be a balanced argument which emphasises the positive contributions of the pharma industry to counteract the negative publicity which portrays it as the last bastion of manipulation and self-serving interests.

The industry needs to be more proactive if it wants to change the public's perception. Currently, adverts focused on enhancing the industry image are appearing in political magazines, specialist disease magazines and on various websites, none of which have extensive readerships.  

These channels only reach a niche audience, completely bypassing the majority of the public. Furthermore, these adverts only obliquely convey positive associations of the pharmaceutical industry. Finally, the ABPI as an industry voice should widen its remit to extend their independent view to the public.

As Silvia Bonaccoroso's article in the BMJ contends: "The pharmaceutical industry must be held accountable through the media and other means just like politicians and doctors but it is in everybody's interest for the achievements of the industry to be highlighted as well."

This balanced opinion is what the industry should be striving for. A comprehensive and sustained effort to promote achievements by individual companies and by the industry as a whole is one method of redress.  

Public perception  needs to be considered as doctors will have both a public and a private opinion. The public are cynical, however, if they are not provided with sufficient information to draw positive conclusions.

Without tangible evidence of 'good works' they will continue to feed off the existing negative perceptions.

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