Med Ed comes of age
pharmafile | May 17, 2007 | Feature | Medical Communications, Sales and Marketing | medical education
Even a casual observer will have noticed the large contribution pharma makes to postgraduate medical education, both in the UK and internationally. It's often said that industry funding accounts for about half of all the CME that takes place in the UK.
But however much it is valued, industry-sponsored medical education has come under increasing criticism, scrutiny and even regulation, and many now look to the US approach in which med ed is provided by specialist organisations operating in a tight regulatory framework as the way forward.
That possible future may be some way off, but its clear that medical education in the UK has evolved in the past few years and more change may well be on the way.
The pharma companies now value med ed more than ever. Although no one publishes comprehensive figures for the med ed business, when questioned Weber Shandwick director Sam Barnes is very clear that the med ed business is growing.
Fishawack Communications commerical director Tim Mustill expresses the situation in stark terms: "Where we used to get perhaps 20% of the pre-launch budget pot in med ed 10 years ago, I think were now coming nearer to 30% of the total."
A route to leadership
Pharma companies have always needed a route to establishing leadership in the relevant areas, but this has been reinforced as pharma companies focus more strongly on building up portfolios of drugs within disease areas, says Barnes.
"CME is one of the key ways of establishing leadership, because it is so effective in building both long-term relationships as well, as establishing a presence. Im not saying satellite meetings, key opinion leader development and all the other things are not important any more they are, but were increasingly seeing clients asking us to help them with this area."
Although Mustill believes that the benefits of med ed have not changed significantly in recent years, he would point to med eds contribution to the way the pharma industry is able to create and shape its market.
"Despite the strict controls, there is still massive scope to influence opinion and create brand receptivity pre-launch," he says.
This kind of activity is often international, which raises the question of how they can work, given that regulatory frameworks, climate of opinion and even epidemiology will vary widely from country to country.
The answer, says Barnes, is that the various national markets have more common ground than might be expected, partly because key opinion leaders are internationally renowned by definition, but also because individual institutions often have enormous influence outside their own country.
"For example, people around the world look to NICEs decisions and frequently follow them, says Barnes. In technology appraisal, it is the gold standard. Guidelines, too, are often international: for example, wherever they are, everyone in cardiology looks towards the American Heart Association guidelines, the American College of Cardiology guidelines and the ESC."
International debate
It's at the international level that CME really comes into its own, not least because getting world-leading physicians around a table to discuss their practices can produce so many valuable outputs.
Statins are a case in point, as treatments come off-patent, new combination treatments come down the pipeline, and the market becomes increasingly valuable as the numbers of people regarded as having high lipid levels continues to grow. The cost is huge and many governments are deciding they cant afford to pay for the patented treatments and are taking action.
In the UK, for example, the NHS is making wholesale decisions about switching patients to the generic versions of statins as brands come off patent. Most notable the East of England Strategic Health Authority announced plans last October to have 80% of patients on statins taking a generic version (usually simvastatin) which is around six times cheaper than the branded versions.
The SHA says the move will save it £23.8 million, and allow it to free up money for spending elsewhere. But the move attracted the ire of Pfizer, whose Lipitor is the market-leading branded statin. It also opens up a debate about the differences between the different statins and which patients should or shouldn't be taking them.
Sponsoring meetings on this or another subject would ensure a debate will take place, but they can also position the sponsoring company as a leader in that field.
Change is in the air
But while med ed grows in importance, the public mood has changed, and the industry responded at the beginning of last year with a new and much tighter ABPI code.
Stricter rules might be expected to be change enough in this area, but Sam Barnes says that some in the pharmaceutical industry have not only embraced both the new code and its spirit, but have now gone some way beyond its terms.
It is clear that some companies have made a concious decision not to sponsor KOLs to attend conferences any more, or to reduce the level of their sponsorship, and instead, have decided to re-invest in different types of CME.
In fact, looking back over the past two years or so, there seems to be an emerging trend across the industry towards less sponsorship of KOLs.
This reduction seems to be increasing the role of CME, for if KOLs cannot attend conferences, one solution is to organise meetings in the UK to discuss findings presented at international conferences.
Barnes believes this is increasingly what is happening: "Opinion leaders will decide to run a series of study days in the UK to discuss some results that have come out of America, and then go to two or three companies to ask for joint sponsorship for the event."
Another change is in the way some of the big conditions are now seen as part of a wider group of co-morbidities rather than as conditions on their own, says Barnes. "One of the big benefits of CME programmes is that they can bring the co-morbidities together.
"Physicians may often be so busy within their discipline that they cant easily keep up with the related co-morbidities. However, within a short CME meeting, they can get the download on what the implications are."
CME is also becoming increasingly international, partly because of the internet and partly because there are real synergies to be exploited. And this is becoming easier because the process of accreditation is becoming streamlined both at European level and locally.
Barnes says: "Where we were only able to get accreditation in each country, we can now also go to the European Accreditation Council for Continuing Medical Education to get it at the European level.
National-level accreditation is also becoming quicker and easier, he adds."
A complex picture
With so much to gain and lose in this complicated regulatory and market environment, who will be successful into the future?
Sam Barnes believes that while there will always be people offering individual elements of the specialist expertise and relationships needed in the marketing mix, the drug companies are recognising major benefits in bringing all the elements of the marketing mix together.
Indeed, such an approach was necessary when it came to recent NICE decisions on a number of cancer drugs. Treatments like Roches Herceptin and Janssen-Cilag's Velcade required not only doctors support through medical education and advisory boards, but also that of patient organisations and the media both aspects of PR.
This is a broad front, and companies working in this kind of area need support from people who understand the implications, Barnes comments, not agencies that can offer one part of the broader campaign.
"What we're increasingly seeing is that were not just running a med ed programme, but programmes that have more than one application so, for example, the physicians at the end of a CME programme might publish a paper about their opinions, which then appears in the media or leads to a debate. Or you might discuss their conclusions with the patients organisations to get their viewpoint.
"Medical education is often best when it is not in a silo, but an integrated part of medical communications."
Winning markets
Not everyone will agree with Barnes' view of a holistic mix of services, but if he is right, does it mean that full-service agencies have all the advantages in the current marketing communications and med ed environment?
He explains: "Historically agencies have often been chosen on whether they had the knowledge of a particular disease area and whether they understand the market. But its more complicated now. Does the agency know how to run a CME programme, does it have the expertise to contact the colleges here and elsewhere across Europe and obtain accreditation in five different countries?
"I think agencies are establishing in-house experts and also building alliances with people they can bring in when they need to. My background was in CME and running advisory boards, and it wasnt until I came into agency-side that I really understood the broader importance of PR.
"Similarly, although Im not a specialist in public affairs and lobbying, I have learned what it can achieve, and at any time I can walk down the corridor to talk to colleagues who are in touch with MPs every day, and of course, I can bring them in as experts. Thats really what full service should be."
Will Hind, who is chairman of Alpharmaxim, is concerned that the term 'med ed' urgently needs to be redefined. He says: "Properly used, med ed is very specific and very few companies actually offer it. In the UK, the term is used for helping to organise symposia, satellite meetings at conferences etc any kind of below-the-line marketing work."
But Hind believes the definition should change and the activity be regulated. "Med ed should apply to continuing medical education or post-graduate medical education. In the States it means enabling education for doctors and health professionals in a professional environment with a very specific set of criteria and objectives, not run by the marketing teams, and entirely set aside from marketing.
"Also, the companies which do it dont also offer marketing communications, while companies that do marketing communications do not do accredited CME programmes."
The 2006 ABPI code doesn't provide for a new definition of med ed, but Hind says there is a clear call from the public for everyone in the industry to be still more open and transparent in the way it operates.
"Wouldn't it be good to go forward and say there are distinct types of company that operate in this area?
"At the European level, there is a desire for it and it would be nice to think that as an industry we could do it for ourselves.
"It would be better to have that than to have it imposed."
Box: Applying the ABPI Code to Med Ed
Published materials form an important part of every marketing and PR strategy, but in the UK, the area has been affected by pharma company caution over the ABPI code.
"The new ABPI code has certainly had an impact on our UK-based business. However, since we do most of our business with the European international pharma headquarters, we have been somewhat cushioned from its effects," says Jane Hunter, managing director of publishers CMG.
Although primarily a publisher of medical education content operating internationally, CMG also offers a range of services, such as conference reporting and website development.
"There was a marked cooling in demand for med ed print products and CDs in the UK. Even though we believe the code exempts medical education from the £6 list-price limit, the wording of the guidelines is opaque, and pharma companies have been unsure how to interpret it.
"We feel sure that medical education is exempt; however, our clients are guided by strict internal rules as to how they can spend their marketing budgets and if management is unsure about how the code should be applied, product managers will err on the side of caution and will not give doctors any item that might be seen as having a value of more than £6.
"We have tried repeatedly to get clarification from the ABPI on how the code should be interpreted, but the reply has been that we should be guided by our clients although it is our clients confusion that has led us to seek elucidation from the ABPI in the first place."
Hunter detects some improvement, however. "In recent months, our clients seem to have become more secure in the interpretation that exempts truly educational products from the price limit, and we have seen an increase in interest in our books and CDs in the UK.
"This is good news for publishers and agencies, and a welcome trend after the rigours of 2006. However, despite this, there is still a good deal of uncertainty and, ultimately, it is only the ABPI that can put the record straight."
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