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A Lucent View

Failure to communicate clearly is pharma's main misdemeanour and it is time to start driving the news agenda

In the 1960s, a visitor asked a cleaner washing the floor of the men's cloakroom at NASA, what are you doing? The cleaner replied: I'm helping to put a man on the moon.

Today, when corporate reputations across the entire pharma sector are suffering, engendering a similar attitude among our staff could help to restore the shine to our tarnished image.

The mud sticks
If critics throw enough mud, some of it, inevitably, will stick. Unfortunately, illegal and unethical acts occur in almost every industrial sector. No company can ever legislate against the actions of negligent, unethical or criminal staff. We must continue to punish transgressors severely, but we also need to be seen taking determined action. Furthermore, we need to do - and be seen to do - as much as possible to eliminate bad practice and the opportunities for unethical and overtly wrong actions.

The new ABPI Code of Practice goes a long way to establishing standards of acceptable behaviour, and senior management needs to implement and enforce its stipulations.

However, a top-down approach from the ABPI and boardrooms will not, I believe, be enough to repair the sector's reputation. We also need to build our reputation from the bottom up. Everyone needs to feel proud that they are working for a pharmaceutical company. Everyone needs to feel like NASA's cleaner. They are not 'just' a managing director, receptionist or accountant; they are helping to save lives.

Against this background, pharmaceutical companies need to consider their corporate reputations among three stakeholder groups: customers, the public and politicians. It is worth mentioning that the ABPI has done some sterling lobbying work recently, a case in point being the increasingly rigorous laws about, and increasing intolerance of, animal extremism. However, I will not consider the way in which we can bolster our reputations in Whitehall in this article. I will focus for now on our reputation among customers and the public.

Unlike in many other sectors, these two groups are not the same, which poses a particular challenge as we attempt to enhance our corporate reputations.

Through the customer's eyes
Our reputation among our customers - ie, doctors, nurses and other healthcare professionals - is generally good. Most healthcare professionals believe that pharma is ethical and works to a high professional standard. Of course, they treat our claims with a degree of healthy scepticism, but that is naturally what you would expect from any intelligent, sophisticated customer group.

In order to gain a clearer insight into how pharma's customers feel about doing business with us, Altana recently funded a survey of 201 respondents including GPs, gastroenterologists, respiratory specialists, practice nurses, pharmacists and primary care organisation staff to understand their views and concerns.

Respondents rated their agreement with certain statements on a scale of 1 (extremely negative) to 5 (extremely positive). Views about the pharmaceutical industry were consistent across the various groups and were, on the whole, neutral to positive: the mean score ranged from 3.8 to 3.4 among GPs and PCO staff, respectively. More than half of respondents (58 per cent) felt that pharmaceutical companies act within the industry Code of Practice, while another 14 per cent stated that this was the case most of the time.

To start with, this forms an excellent foundation upon which the new ABPI Code of Practice and other ongoing initiatives can enhance our corporate reputations. Indeed, the findings proved to be reassuring: few healthcare professionals seem to hold the negative view of pharma that is apparently more widespread in society. When asked whether they thought the pharmaceutical industry operates within strong ethical boundaries, the mean score was 3.3 out of 5 across all healthcare professionals.

Nevertheless, we could do better. We should, for example, continue to enhance transparency. Our survey found that many gastroenterologists, respiratory specialists and GPs believe that pharmacos do not always report clinical trials in a balanced way. Approximately one fifth felt that we should present more balanced information. The open-access clinical trial database should help as, even if our customers do not regularly interrogate the database, it shows that we are prepared to be open and transparent.

As a sector, we also need to ensure that our sales and marketing materials are evidence-based and reflect the needs and values of our customers. These moves, along with the disclosure of commercial involvement at meetings, conferences and in scientific papers, should further reassure customers that our actions are transparent and above board.

Directly representative
Practice nurses are, at present, less cynical about the pharma sector than their physician colleagues, according to our survey. Some 80 per cent felt that they had valuable relationships with pharmaceutical representatives and 78 per cent believe that representatives offer an important and effective service. Yet, the sector's standing, in general terms, is highest among pharmacists, who seem to have the most positive view of the industry's ethic.

Over the next few years, the growing number of supplementary and independent prescribers will expand our customer base among these groups; dramatically so in some areas, such as asthma. We will need to retain this goodwill and build on our status among nurses and pharmacists.

The best way to achieve this is through positive, transparent partnerships. Most firms are developing tactics and strategies that can bring value to customers by being real partners in healthcare delivery. This should bolster our corporate reputation among healthcare professionals and help reps access key customers.

Our representatives are our ambassadors and they are likely to remain our public face for the foreseeable future. Despite all the hype surrounding potential novel business models, new media and high-tech communication channels, the face-to-face sales call remains the preferred method for pharmaceutical companies to communicate with their customers.

Altana asked respondents to rank various communications methods. GPs, practice nurses, pharmacists and PCO staff all rated the rep visit as their preferred method.

Gastroenterologists and respiratory specialists preferred, respectively, medical information only and congresses. Nevertheless, gastroenterologists and respiratory specialists still ranked face-to-face meetings more highly than, for example, email, speaker meetings and group meetings with representatives.

Indeed, face-to-face meetings may become even more important over the next few years. Most companies are moving beyond a simplistic sales call into developing ongoing relationships with healthcare providers which give true value and help improve the health of the local population.

Marketing, increasingly, is less about whether drug A is 'better' than drug B, and more about discussing how the firm can help to meet local healthcare goals. It means growing the market rather than trying to switch sales from one brand to another. It may mean positioning our high-value brands behind generics, rather than attempting futilely to persuade GPs to prescribe them first line.

This pragmatic approach develops confidence between PCOs and reps while enhancing our reputation. Furthermore, the reps will help to deliver on these relationships, which often require closer and more regular contact with customers than the traditional, simplistic sales call. To a certain extent, primary care commissioning and other changes in the NHS, alongside an increasingly competitive market, have forced us to re-evaluate and re-tool our sales and marketing models.

We will probably look back and view this change as a watershed in our relationships with customers. Our reputation among our customers can only benefit from the closer relationships needed to develop such partnerships.

Enhancing our public reputation
Improving our reputation among the public poses a tougher challenge. At the heart of the relationship is a paradox. On the one hand, there is a clamour for new drugs, such as Herceptin. Yet ironically, few people seem to link the medicines they take each day, or the latest 'wonder drug' to hit the headlines, with the sector that developed the medication.

Most patients take OTC or POM drugs, yet few can name more than one or two brands, or a couple of pharma companies. Some vocal groups help to fuel a public perception of pharmacos as the epitome of an evil multinational effort to make unwarranted profit from people's suffering, enticing doctors into prescribing expensive drugs through lavish hospitality.

Obviously, we need to get the message across that the pharmaceutical sector works with the NHS to save lives, improves quality of life and offers excellent value for the taxpayer's money by preventing hospital admissions. I believe that we can approach this thorny, perennial problem in two ways.

Firstly, we need to take a top-down approach. Every SmPC, every PIL, every patient information leaflet, should explain that the medicine is an example of pharma working with the NHS to improve health. Every local initiative that we help to fund should mention that it is a collaboration.

We also need an advertising and publicity campaign to raise awareness of the sector's importance economically and to our health as a nation. The ABPI needs to take the lead here. It does as much as it can with its current remit and structure, yet perhaps it is time to look at how the ABPI can move forward.

In a world dominated by continuously updated news 24/7, we can no longer afford to be reactive. We need to explore ways in which the ABPI can make (rather than just respond to) the news and, in so doing, change public perception about pharma.

The sobering reality is that we often fail to take charge of the news agenda. There seems to be a view - as one example - that pharmacos only develop new drugs that will reap significant profits in the developed world; a view, Altana's survey suggested, held by many of our customers. However, a recent briefing document from the ABPI reveals that sanofi-aventis is working with the World Health Organisation to combat African trypanosomiasis, Pfizer is donating cash and medicines for trachoma and cholera and GlaxoSmithKline is funding (still, since 1993) an international, co-ordinated research programme to fight TB.

Yet from some news stories, you could believe that pharma prevented people with AIDS in the developing world from getting the drugs they need solely to protect their patents. Our failure to get clear messages across has contributed to our poor image.

Secondly, everyone needs to take every opportunity to stress the importance of our work. At a recent dinner party, I watched the eyes of someone who had asked what I do for a living glaze over. I told him that I was the MD of a pharma firm but, in retrospect, perhaps I should have been more like NASA's cleaner and pointed out that I make an effort towards saving people's lives.

We could improve our image considerably by networking with friends, neighbours and acquaintances. Pharma employs 73,000 people directly, and perhaps 250,000 indirectly. We can all act as envoys; 73,000 people can make a lot of noise, and if you make enough noise, people listen.

However, this means that everyone, from the cleaner to the MD, must buy in to the vision. Our mission statements must be more than corporate fluff. We need effective internal communications to show how everyone fits in: why their job helps to save lives.

Unfortunately, there is no simple and quick way to improve our corporate image. Winning hearts and minds means advancing on several fronts and will take time. We need to work with our customers and build on the current opportunities to become real partners. We need the ABPI to redouble its efforts in leading top-down, proactive consumer awareness. We need every single person in every company to feel that they are improving the health of their friends, neighbours and loved ones - and we need them to be proud enough to let people know of their efforts.

It can't be any harder than putting a man on the moon.

The author
Steve Glass is the managing director of Altana Pharmaceuticals

2nd September 2008

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