Communicating with patients

pharmafile | December 5, 2005 | Feature | Sales and Marketing |   

Despite little prospect of the restrictions in Europe on communicating directly with consumers being relaxed, the issue of DTC communications stubbornly refuses to go away. Throw the subject into a discussion in a room full of pharma marketers, and you can stand back and watch the arguments fly back and forth, most of them well-rehearsed and reflecting entrenched positions.

And yet the unmoving regulatory environment and the long-made-up marketing minds hide a subtle shift in DTC communications. Understand what is happening, and how even within the confines of European regulation DTC comms can be harnessed, and that Holy Grail of pharma marketing, a competitive advantage, can be identified and seized.

Inevitably, when this subject is raised, attention shifts across the Atlantic. Since relaxation of DTC advertising restrictions in the US in 1997, millions of dollars have been spent promoting drugs to US consumers. Proponents of the practice claim that this continued spend is only possible because it works – and yet at last we are starting to see a change in attitude towards DTC advertising.

Backlash would be too strong a word, but there is certainly a re-evaluation of its effectiveness, in the light of conflicting research findings, and a growing distaste at the aggressive and unsuitable product promotion that has undoubtedly occurred.

DTC advertising in the US slowing down

According to TNS Media, the enormous growth in DTC advertising spend during the last decade has slowed more or less to a standstill ($1.9 billion in the first five months of 2005), as companies question whether their blunderbuss approach is really working.

The evidence is conflicting. An FDA study amongst 1,200 patients showed that 90% had seen a particular drug ad, one third of them had gone to see a doctor, and 80% of those doctors had prescribed the product.

This positive outcome (for the industry at least) seems to be backed up by a study carried out earlier this year by the University of California, which found that advertising drugs to patients has a profound affect on the way doctors prescribe.

If this suggests that DTC advertising is an unqualified success, then that is an inaccurate picture. Abuses and simple bad targeting have undermined its effectiveness. According to Rebecca Robins, global marketing director at Interbrand Wood Healthcare, one fundamental issue is the question of what a company is trying to communicate about a brand, and what it is trying to achieve.

"Time and again, companies have fallen foul by trying to communicate what amounts to very complex information, in the absence of any real context. Furthermore, precious little consideration has been given to the different communication needs of a life-saving oncology drug versus a life-enhancing ED drug, and the role and responsibility of DTC in this.

"Another fundamental issue is the choice of media. A 30-second TV spot is not optimally geared to a dynamic where any benefit message needs to be countered by a raft of regulatory detail about the potentially life-threatening side-effects. The net result is that messages are at best, mixed, but more frequently, lost altogether."

Robins believes that at a time when the industry is under the spotlight as never before, the disconnect of DTC advertising has done more harm than good.

"Instead of the wonder drug that everyone anticipated, it has become more of a fly in the ointment, as DTC advertising has become a primetime free-for-all for every kind of rx drug.

"DTC advertising in the US has effectively devalued what it set out to do in the first place. The role of those communications has been misunderstood, to the point where potential consumers are actively switching off from and are being driven away by ads running at prime family time that are talking about erectile problems and other 'health-sensitive' information.

"There was a real opportunity for companies to communicate properly with consumers, but this has been radically misunderstood and mis-articulated by using the wrong media and putting out the wrong messages."

Empowering and informing patients?

The industry's arguments in favour of DTC advertising in the US point more to the theory that they are non-hard sell communications which inform and empower patients and allow them to access better treatment.  

This argument was summed up eloquently by Paul Anthony, chief medical officer of industry body The Pharmaceutical Research and Manufacturers of America (PhRMA) in a written statement to a US Senate Special Committee as recently as September this year.

"DTC advertising has been proven to be beneficial to American patients. And, continuing regulatory oversight by the FDA helps ensure that the content of DTC advertising informs and educates consumers about medical conditions and treatment options. PhRMA and its member companies have a responsibility to ensure that ads comply with FDA regulations. We take that job seriously. We want to continue to be a valuable contributor to improving public health.

"DTC Advertising can be a powerful tool in educating millions of people and improving health. Because of DTC advertising, large numbers of Americans are prompted to discuss illnesses with their doctors for the first time. Because of DTC advertising, patients become more involved in their own healthcare decisions, and are proactive in their patient-doctor dialogue. Because of DTC advertising, patients are more likely to take their prescribed medicines."

Opportunities in Europe

But ultimately any industry will only continue pumping billions of dollars into an activity if it can be shown to deliver a return on investment – in other words measured sales growth through patient pull, with a concomitant maintenance of a strong price.

While DTC advertising is almost certainly not on the horizon in Europe, even in the long-term, Anthony's final point is important when it comes to examining the possibilities for DTC  and direct-to-patient  communications this side of the Atlantic.

"It's highly unlikely that there will be any huge regulatory changes in Europe," says Dr Paul Stuart-Kregor, director of specialist pharma consultancy firm The MSI Consultancy. "But that does not mean that the pharma industry can't be proactive in delivering valuable and useful information to patients. It needn't be about influencing actual prescribing patterns in a full-on, promotional way. DTC communications can play a useful role in helping to increase compliance/concordance, which is just as valid a way of driving up sales of product, with the added benefit that it actually helps the doctor-patient relationship by helping improve the health of the patient."

Stuart-Kregor cites as one of the biggest opportunities the growth of the so-called Expert Patient amongst the UK's population. "As patients are encouraged to take more responsibility for managing their chronic conditions, then they will become more hungry for good quality information.  

"Properly formulated, non-promotional information fed through to them via clinicians and patient groups, can have a powerful influence on the way they self-manage their diseases."

Interbrand's Robins is similarly careful to distinguish between out-and-out promotion to consumers and providing information for patients.

"We should be careful about definitions – when people talk DTC, what is meant is direct to consumer advertising. However, perhaps what should be engaged with is direct to consumer information, which takes us to the crux of the dynamic between direct to consumer communications being leveraged as a sales or information vehicle.

"DTC needs to be thought of – and acted on – in a much broader context. It should be about communicating to patients about a condition, about driving awareness and improving compliance."

Communications restrictions

All well and good, but isn't it becoming ever more difficult to achieve effective communications with patients? The noises from the recent Commons Health Select Committee report – which explicitly questioned the so-called practice of disease-mongering as part of disease awareness campaigns – will make the industry even more reluctant to step out of line, a stance reinforced by the new ABPI Code of Practice unveiled last month, and which comes into effect at the beginning of 2006.

One of the key changes in the new Code is that relationships with patient groups and the provision of information to the public are covered in greater depth. The change has come about following increased concern about abuses in the industry, according to ABPI president Vincent Lawton.

"This has been a fundamental review of the code, and follows a far-reaching public consultation exercise. We have listened to these comments and taken action accordingly," he says.

The part of the code dealing with the industry's relationships with the public, and with patient groups, has seen important changes. Definitions of what information can be supplied to the public have been improved to give more guidance.

There is also an important new clause concerning relationships with patient advocacy groups. While companies are permitted to work with PAGs, their involvement must now be made clear, including making public via their website and/or annual report, a list of patient organisations to which they provide financial support.

In addition, a written agreement must be in place with every organisation, spelling out exactly the terms of the relationship and funding of every significant activity.

Overcoming the barriers

According to Sarah Hefford, marketing manager at AXA Assistance, which has been providing DTP programmes in the UK for a decade, these barriers, like those which have come before them, are not insurmountable.

"Guidelines for patient communications give clear direction towards what's possible. The key principle, however, is that patients cannot be directly sold prescription medicines. So, provided the patient is taking the medicine at the time of the communication, and it agrees with the doctor's wishes, a direct-to-patient communication to improve clinical outcomes is not only legal and acceptable, but also provides a service to the patient and healthcare system."

Hefford says that regulators are wising up to the fact that some DTC communications can be beneficial, while others are inappropriate.

"The root of the confusion lies with unclear terminology. It may be helpful to split communication to the public into DTC (Direct To Consumer, who may or may not be taking your company's drug) and DTP (Direct to Patient, who are taking it).

"When applied to communications about specific medicines, the former is off limits in most European countries  and you can see why. Drug-focused DTC communications, which attempt to influence a person to request a prescription-only medicine, places unnecessary pressure upon healthcare professionals, and may confuse or even alarm some patients.  

"By contrast, drug-focused DTP communications, aimed at those who are already taking the medication and need help with it, aim to improve clinical outcomes, thus benefiting every stakeholder: the NHS, the pharma company and – above all – the patient. So DTC can be thought of as there to sell or grow a market; DTP is there to help patients. Critically, regulators in all European countries are awakening to the difference."

But it's not just DTP which is permissible. In Europe, pharma can run disease education programmes, use third-party patient groups and make the most of PR. And advertising – even direct response advertising – can play a part in these campaigns (although they cannot, of course, promote a particular product).

In addition, the huge penetration of the web in the UK's homes – second only to the US – coupled with a high proportion of that penetration being Broadband, means that the internet presents a means of providing accessible, up-to-date and targeted communications. The web is already one of the main ways consumers access healthcare information, and it has the big plus of providing two-way communication.

Perhaps the best way of communicating with consumers – whether they are current patients or potential users of its products – is through creating partnerships which meet the needs and aspirations of all stakeholders, patients, doctors, PAGs, the healthcare system and industry itself.

Because increasingly knowledge-hungry patients are asking for more information, and if pharma can help third parties provide it in a way which is useful and non-promoting, then those third parties will become advocates for the industry.

DTC communications in Europe will never – at least in the foreseeable future – be about promoting individual products. But it can already be about motivating patients and improving compliance, two powerful ways to help build sales and increase ROI.

Those who think the regulations prevent them from doing this will be missing a trick.