A little knowledge goes a long way

pharmafile | February 12, 2004 | Feature | |   

Probably one of the biggest problems the pharmaceutical industry has had to overcome over the years is the question of how to seamlessly marry clinical, scientific expertise and innovation with common sense commercial acumen. After all, in the eyes of the customers, a product is only ever going to be as good as the way it is portrayed by marketing departments.

Companies can have the most efficacious and exciting new chemical entity in the world, bursting to get out of the development stage, but if the core marketing messages aren't there it is unlikely to make a big splash in the market.

In many ways, medical education was seen as the attempt by the industry to link up the progress being made in lab work in the early stages of the development process with the brand communications which happen much closer to the time of launch. Long before the product was launched, doctors had to have an idea of the disease area that it would fit into and how relevant it was to their population of patients.

In this age of strategic communications, integrated marketing campaigns and key opinion leader development, one could be forgiven for saying that the term 'medical education' has become just a little dated. Springing up from the publication planning component of the marketing mix, it has gradually evolved over the last 30 years.

Starting off as isolated communication projects which often had little to do with other marketing messages, let alone the all-important brand, medical education is now seen as a vital ingredient of pharma companies' communication programmes.

According to Mark Lewis, managing director at Medical Knowledge Group, medical education arose out of the need for companies to think about product launches and activities earlier in the process both from a commercial sense and a product development sense. He says that it was needed to fill a vacuum at the start of projects where not much attention had really been paid to communication.

Med ed unique role

"Med ed has evolved over the last thirty years as an activity that was needed to link the needs of clinical development with the needs of international and local marketing," he explains. "In my view, med ed has a unique role in activities such as very early stage publication planning and out of that has emerged the need to concentrate more on activities such as positioning development, message development, gap analysis and clinical trials rationale."

According to Physicians World director, new business, Dr Sven Schaeffer "Med ed gives you the chance to start pretty early in your development cycle and to start building up an image in acertain indication or area of medicine. It offers you an early opportunity to enter into a new field but in an ethical and neutral way."

Trevor Sills, account director at Healthworld Communications Group, says that medical education has grown in importance as evidence-based medicine has become more powerful.

"Nowadays many prescribing decisions have to be based on robust clinical data and strong therapeutic and clinical principles," he says. "I  think med ed is becoming increasingly important as an element of pharma communications as it generally been accepted that in order for physicians to really adopt a product in terms of message or a certain proposition then it has to be based upon solid foundations of evidence."

Both Mr Lewis and Mr Sills are agreed that medical education now constitutes a fundamental component of the marketing mix, although they also admit that it can sometimes be a difficult concept to accurately define.

"Frankly I think 'medical education' is a complete misnomer, a very dated term," says Mr Lewis. "It means different things to different people globally or nationally and there now an enormous amount of carry over with PR. I would consider med ed as a very early educational brand communications activity required in project development. We tend to call it 'strategic medical communications': fundamental communications that support the product position and messages by way of activities that are virtually always peer-reviewed and closely relate to the science involved."

PR agencies and CROs getting involved

He continues that med ed has its clearly defined place in the drug development 'line' sandwiched between drug discovery and the work done by contract research organisations (CROs) on one side and PR and advertising/branding on the other. However he also accepts that the edges have become blurred on both sides with CROs and PR agencies starting to increase their involvement in the medical education pie.

Mr Sills of Healthworld, which focuses on medical eduation and publication planning, says he is not surprised that PR agencies have moved into the medical education sector but argues that clients still have to look at each sector's skill base and make distinctions. He says that while medical education has a foundation for evidence and speaks towards rational prescribing, PR agencies are most effective in working with opinion leaders, presenting emerging data and making use of the powerful network they have built up with the media.

"I believe that PR and med ed can work effectively together," he says.  "I'm not a big authority on PR but my view is that med ed is based upon an understanding of clinical and therapeutic principles and presenting impactful and robust evidence through good educators and communicators. If PR agencies feel they can offer this, I don't wish to deny them this opportunity – in fact I think it's pretty wise thinking.

Europe becoming more regulated

Physicians World Dr Schaeffer believes medical education retains a specialised nature and consequently the industry should stick to specialist providers. "Med ed very much depends on content and that has to be developed with the experts who ultimately have to communicate it," he says. "It's a very specialised system with certification, quality and learning control and accreditation."

He also points out that international medical education in Europe is now moving towards a more regulated system such as the one that currently exists in the US, where programmes are quality controlled and assessed by accreditation bodies such as the Accreditation Council for Continuous Medical Education (ACCME).

With both CROs and PR agencies starting to develop medical education capabilities, there is no doubt that the sector has changed from a relatively quiet cutting edge area into a much more crowded and competitive one. Lucy Kirkpatrick, medical education director at full-service communications agency Avenue HKM agrees that the sector has become much "noisier" and the keen sense of competition has thrown out new challenges to those companies wanting to grab their share.

"What we often do when looking at med ed programmes is try and ascertain what value we can add to them that perhaps isn even related to the actual product or disease area that nonetheless doctors will find useful," she comments.

"It's about finding another unmet need for the audience; that might be skills training that they wouldn't get elsewhere, bulked onto the programme. Another challenge that she says UK companies have to take into consideration is the birth of new policies and institutions such as the National Service Frameworks (NSF) and NICE which have a bearing on prescribing decisions.

"There are now more of these formal organisations which are providing doctors with guidance for managing different diseases and if your programme doesn't fit in with their guidance then you have an issue," she states.

"Before the days of NICE and the NSF, people could develop their own guidelines but now doctors are looking more towards formal government driven initiatives. You have to be one step ahead in terms of anticipating the way the framework you're working in may shift. It's not a case of being shackled, it's just another thing to bear in mind."

The rise to prominence of global branding is also having a bearing on the importance of medical education initiatives. Mr Lewis says that despite the very different healthcare arenas evident in each country, "pharmaceutical companies are increasingly trying to balance the need to standardise their approaches to achieve consistency and cost effectiveness, correctly I think, but the markets will always be differentiated by micro-needs and local national factors."

Medical education bound globally

Mr Sills believes that medical education is bound globally and whether the country concerned is North American, South American or European, programmes have to be run in partnership with senior heavyweight opinion leaders: "The way to get adoption of either new treatment principles or to get people to understand medicine issues is through the old teaching process; you still have to work with impactful opinion leaders who are good educators and communicators and that's the same the world over."

All agree that the big challenge in conducting a medical education programme is overcoming the natural reticence and resistance that some doctors will put up against an initiative that is after all sponsored by the pharma industry.

Mr Lewis refuses to call it scepticism: "Scepticism is usually due to the fact that someone else has been there before and maybe not done such a good job at communicating the new therapy," he says.

Avenue HKM'S Ms Kirkpatrick is of the opinion that doctor's reservations throw out a healthy challenge to agencies to be increasingly creative and provide them with an interesting, new forum they may not have experienced before.

"When keypad voting came out for the first time, you could actually measure interaction and the audience could see it in real time paving the way for a two-way dialogue," she enthuses. 'It was a very exciting way of delivering med ed. You have to use a variety of methods to make the meetings more interesting; it's about finding out what excites them. They are incredibly busy and just getting them out of their surgeries can be a major achievement."

Just drug promotion in disguise?

While medical education companies will always stress that their programmes are highly independent, ethical and neutral, critics like to point out that pharma companies are happy to spend large sums of money on sponsoring such events. The question of whether medical education borders on and even sometimes strays into covert drug promotion has been bandied around since the practice began.

Mr Sills says that such insinuations should be regarded as a deep insult to the "many physicians who do sign up to med ed programmes as well as their senior colleagues who put excellent programmes together.

"Physicians know that if they are going to a med ed seminar whether at a major congress or at their local university, they are at some point going to hear something about a product," he says. "But at the end of the day, they also know that it's their call in terms of the robustness of the data that will be presented to them."

According to Mr Lewis, if medical education activities are to be called into question, then the medical profession itself probably has to be too: "Virtually everything we do at our level is transparently peer-reviewed and if activities are not approved to the highest level of medical ethics and scientific correctness they should not (and don't) go any further."

Dr Schaeffer accepts that the link between pharma and medical education can be "difficult to talk down" but argues that a line of quality control is now being established throughout the whole process. "Med ed specialists have a role as a third party to work together with physicians to make sure the programmes are balanced and credible," he states. "It's in the interests of the experts who present the material to make sure it's balanced and credible otherwise they would be seen as company promoters."

As medical education continues to develop, its almost symbiotic relationship with other elements of the marketing mix (in particular PR) makes it very difficult to predict what the future holds in store. Mr Sills says that in his opinion, with the rise to prominence of evidence-based medicine, medical education is going from strength to strength and forms an increasingly powerful partner in the marketing mix. Ms Kirkpatrick thinks that with personal education moving towards personal development plans, medical education needs to find a way of tailoring doctor's personal education.

In an industry where consolidation has played a big part in recent years, no one can rule out a future scenario of the full-service communications agency delivering a wide-ranging package of medical education, PR and CRO capabilities – in short catering for all the needs of a product's early development cycle.

"We're still asome way from that," says Mr Lewis. "The client wants servicing simplicity, multi-skills, and cost efficiency but should also be very concerned about long term creativity, focused commitment and total confidentiality. That's a big package to to offer any client."