Infernal communications
pharmafile | October 22, 2003 | Feature | Research and Development |Â Â marketing, medicalÂ
One of the great things about being asked to put your thoughts down on paper is that it immediately demands that you focus your ideas: conversely, if you don't have ideas in your head, you have to go find, and assemble them. Serendipity takes over and you keep falling over snippets that you might not have paid attention to before.
Take this example, which appeared in Yahoo! financial news of 12 March, 2003, and is a direct quote: "Glaxo AIDS drug fails NIH trials: AHF says, once again, GSK marketing triumphs over science." (http://biz.yahoo.com/prnews/030311/latu110_1.html). It is not my objective to focus here on an individual organisation, but to use examples where it is apparent that there have been breakdowns in intention between the marketing department and the medical department. Was there a stumbling block between two departments understanding each other? Can potential stumbling blocks be identified, and should the pharmaceutical industry acknowledge that more work needs to be done on internal communication before it claims expertise in communicating its message to the outside world?
It is a sad fact that no matter whom I have asked, all agree that there do seem to be barriers to effective communication between medical functionaries and their marketing colleagues. It may even be worse than that, in as much as it may be taken for granted that it is the status quo, and anything else comes as a big surprise. Robert Clements, Senior Product Manager at Forest Laboratories UK, said that he saw the divisions almost as two nations divided by a common language. "The words the pharmaceutical industry use often seem to have different meanings to marketing and medical, and can end up pulling in two different directions," was his summary. A more benevolent interpretation was given by a senior financial officer in a multinational company, who commented that it was not always clear that marketing understood the information that they had been given by medical to work with. He went on to quip that clever marketing can make a bad product a success but that is probably true of many products, not just pharmaceuticals.
It is not uncommon for medical and marketing to have differing perceptions and interpretations of information about their products. At the very least this can create confused promotional messages, and at worst result in legal action from a regulatory body or censure from a self-regulatory body.
Communication differences between medics and marketers
There are a number of self-evident truths in the pharmaceutical industry, and one of the simplest ones is that the key objective of the industry is to make a profit from selling safe and effective medicines for identifiable illnesses. Despite political pressure brought on behalf of third world nations, the industry conventionally is not a group of philanthropic organisations. Marketing departments find it very easy to take this message on board, and most of them will have employees with some business training. Medical departments are different, employing medical and scientific graduates. Their training is fundamentally different. If psychometric profiling is done, using simple tools like Briggs Myers scoring, they are poles apart. In Europe, doctors are not trained to see patients as potential profit centres, and certainly not to see dead patients as 'zero income generators'! Medics and scientists place a high value and reliance on truth, as they interpret it, and can become easily offended if their perception of truth is perverted. Marketers understand that they still must tell the truth, but learn that truth may not actually be an absolute. One can be economical with the truth – a favourite standby of the Clinton Administration – or select which aspects of the truth are brought to the forefront – see the current UK Government for many superb examples! The big advantage that marketers have over medics in the industry is that their success is more easily measured in terms of income generation it is extremely difficult to quantify the proportion of any company's profit that is directly attributable to the activities of the companys medical advisors.
Probably the most frequently heard phrase when marketing intentions are aired to the medical function is 'You can't say that!' Robert Clements proposes that that may actually be a good thing, as a creative friction is generated. In the very worst of scenarios, an 'us' versus 'them' attitude emerges between medical and marketing. This is insane, as both groups are working for the same organisation and their objectives should be the same: to offer an effective marketing message and promotional platforms that help sell a companys medicines. Is it that there is insufficient marketing training of company medics, and if they were trained or actually performing a marketing function, then they would see the light?
This paradox actually helps highlight one of the key functions of the company medical department. It is there to protect the company from its own worst excesses: it should act as the moral voice at all times, and its critical function is to act in the best interests of the patients while preserving the corporate objectives of selling effective and safe medicines profitably. At some point there is a fine line that the medics must draw and explaining this to marketers can be difficult. Guidelines and legislation help define these lines, but often it is down to their good judgement, and they have to ask themselves the questions 'What would I do with this information if I was a doctor down at the local health centre? Does it stand up to critical appraisal?'
The line is sometimes made more difficult to see because of commercial confidentiality and contractual obligations of employees within the pharmaceutical industry, as in the case of Dr Andrew Millar, who was Head of Clinical Research for British Biotech in 1998. His employment was terminated and he was sued when he 'breached confidentiality' by discussing his concerns about the company's research and commercial development with two fund managers at Perpetual, an investment manager holding just under 10% of the company's shares. He had concerns about the interpretation of clinical trial data, when other company members were publicly optimistic about a new cancer therapy.
In a subsequent court case, his actions were vindicated when in June 1999, just before the Public Interest Disclosure Act came into force, British Biotech offered to settle the case with Dr Millar for an undisclosed, but reportedly substantial, sum. As part of the settlement, the company also publicly stated "that Dr Millar has always acted in accordance with his medical opinion, his professional obligations to patients involved in clinical trials, his conscience and his view of the best interests of British Biotech." One wider interpretation that may be put on this series of events is that the company's medical advisors and medical director have a primary obligation to patients who use their company's medicines, and this overrides the marketing needs of the company.
Another historic example demonstrates the potential pitfalls of marketing zeal over medical best interests. In 1986, the Medical Director of Roussel Laboratories was prosecuted under the Medicines Act. The background of this prosecution was that animal data had been extrapolated (unjustifiably) to form the basis of the unique selective prostaglandin inhibition and gastric tolerance promotional claim of the company's non-steroidal anti-inflammatory agent, Surgam. Normally, one might expect that sort of transgression to be sorted out at ABPI level, but clearly the MCA wanted to make a point about its role in the control of advertising of medicines.
The question remains – why, in the absence of good clinical data, did the medical director of the company sign-off the promotional items with this questionable claim, when it is common practice to treat animal data as contributory rather than conclusive evidence of a medicine's action in humans? Was there a strong influence from the marketing department, and if the marketers had had any notion of the potential consequences of their efforts to gain a commercial edge, would they have thought several times before creating the promotional platform?
Dr Joan Barnard, author of 'The Code in Practice', is of the opinion that marketers are tempted to only pay lip-service to the ABPI Code of Practice and get around the rules rather than accept the principle of working within them – a recipe for conflict with medical signatories.
Pure science and marketing will always conflict
A common scenario that can leave neither side feeling satisfied is the thorny subject of clinical trials. There does seem to be a fundamental division between what medical and marketing believe the role of clinical trials to be. The medical function will typically take the stance that a clinical trial is a well-designed experiment intended to answer a specific question. The marketing department will see a clinical trial as being a way of creating promotional copy that will show that their product is better than the competition.
In the post-marketing phase, the marketers are probably right, and phase IV trials should be there to reinforce and extend the role for a product with marketing authorisation. In the pre-marketing phase, things are trickier, as it can be difficult to translate an esoteric and subtle endpoint with statistically significant superiority that works well for regulatory purposes into a marketing platform. The problem seems to be forcing the combined might of medical and marketing to turn data into easily understood patient benefits.
From the discussions above, it sounds as if there is never any useful dialogue between medical directors and their marketing counterparts. It is true that there are stumbling blocks and cultural chasms that get in the way of internal communication of information and intentions. Sometimes it seems the only time when useful interaction occurs is when disaster strikes, and damage limitation is the order of the day. Living proof of this is enshrined within the quarterly reports of the Prescription Medicines Code of Practice, and personal experience suggests that when the going gets tough, dial M for medic.
Improving dialogue between medical and marketing
While not comprehensive, the following model may be worthwhile considering as a method of improving communications between medical directors/departments and marketing directors/departments.
In order to fulfil their roles, it is natural that there will be differences in culture, outlook and perception of risk when the medical and marketing departments are compared. However, rather than each trying to mould the other to its own image, these differences should be respected. Arguably, each should be offered experience of the functions of the other, such as participation in meetings, training sessions, conferences. Both sides should take the time to spend days on the road with the sales representatives so that they hear 'the word on the street'.
Each side needs to give the other personal space. One model suggests that the best way for a medic to communicate with a marketer is to work in the marketing department – funnily enough, it is never the other way round. However, there is a potential conflict of interest if a medic becomes answerable to a senior marketer, as the medic should always act in the best interests of the patient.
The involvement of the medical function in a marketing project should happen at the earliest possible opportunity, preferably before anything goes down on paper or budget spent. It is up to the marketers to confirm their own understanding of the boundaries of any promotional platform. Meetings with adverting agencies may include a medical input. It is often amazing just how little lip-service is paid to the codes of practice by the agencies. Marketing departments must take responsibility for promotional activities generated by their contracted agencies, and they cannot be relied upon to adhere to guidelines.
While making the medical function subservient to the marketing function might sound like the ideal scenario that will never happen, consider creative possibilities: close (working) relationships between inter-departmental members can work wonders.
Inclusivity may be the name of the game, and opportunities should be actively sought where the two divisions can come together in situations where conflict is unlikely. Using the adage a'dversity makes strange bed-fellows', good working relationships are often built after having to deal with a problem. The critical message is that when working together on a crisis, the end result should not be one side blaming the other.
Medical directors should be encouraged to educate their marketing departments to complete high-quality clinical trials that are commercially relevant and medically sound. Easily understood endpoints and their significance should be agreed between medical and marketing before pen is put to paper for a protocol.
Keep it simple and it is more like to work for everyone.
Dr Martin Goldman is Senior Medical Advisor at Forest Laboratories, Europe.
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