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Conflict resolution

Initiating conversations with customers is the logical choice when science and authority tangle

In recent years the pharmaceutical industry has found itself in a number of public showdowns where science and authority have clashed. Avandia and Vytorin, drugs to manage diabetes and cholesterol, are the most recent examples, but not the only ones.

According to Stanley Plotkin, a noted physician and member of the Institute of Medicine: "The great thing about science is that authority doesn't always hold sway. Eventually scientific studies will be the deciding factor and outweigh prevailing opinion."

As it turned out, studies proved Plotkin right and authority wrong about his own endeavour, the rubella vaccine.

The conflict between science and authority is an old and persistent one that now routinely challenges the pharma industry and its reputation. Maybe it is time to reconsider the way we manage our communications when these disputes arise.

A few examples can help illustrate the science/authority problem: Copernicus, the Renaissance astronomer and mathematician, challenged scientific orthodoxy with observations that proved the earth moved around the sun. This was a stunning discovery that provoked a vigorous, but ultimately unsuccessful, defence by those who argued for an earth-centred universe.

Fast forward four centuries to Barry Marshall and Robin Warren, Australian researchers who, in the 1980s, challenged the prevailing medical dogma that lifestyle and stress caused peptic ulcers. By extension, their theory challenged the conventional wisdom that histamine antagonists were the treatment of choice for this condition.

Gastroenterologists and pharma argued against the new insights, but Marshall demonstrated that stomach ulcers were caused by a bacterium, Helicobacter pylori. He then drank the broth containing the bacterium to prove it. An antibiotic eradicated Marshall's H. pylori infection and today antibiotics, not histamine agents, cure most ulcers.

In 2005, Marshall and Warren were awarded the Nobel Prize in physiology/medicine.

The beautiful thing about science is that it is always self-correcting, whether it's navigating our place in the universe, debunking the cause of ulcers or proving the safety of a medicine or vaccine.

The pattern is the problem
Billy Tauzin, PhRMA's president and chief executive, commented recently that public trust is the one great problem to seriously challenge the industry.

The way pharma constructs and argues its case, however, has left others unconvinced and sceptical of its intentions, ie the pattern of argument and engagement has become part of the problem itself.

A study raises questions about what we believe we know about a drug. New finding are interpreted not so much for what they are, but rather for what we feel they represent: a risk, a conclusion out of context, a flawed interpretation; a marketing threat; a media event. There are ways to catalogue and minimise the risk, but rarely do we engage in a mutual gains approach to these types of conflicts. Rather, we dig in for a protracted defence, convinced that our science should be the final word.

As organisations, we appear uncomfortable with the give-and-take that science requires, especially when the science is not our own.

In the cases of Avandia and Vytorin, the companies relied on their science and authority – the customary approach – but failed to appreciate the rules of engagement and how one's position can be undermined. Richard Clark, CEO of Merck, recently acknowledged as much while discussing the ENHANCE study. "There's a trust deficit," he said. "I have to blame us. We need to do a better job."

Given the apparent consensus around the issue of trust, it is doubly important to understand which behaviours heighten the likelihood of failure. 

Rules of engagement
The first rule of engagement is to avoid the confidence conundrum. This describes the predicament we find ourselves in when the pronouncements we make about the certainty of our position or findings (eg, there is no credible evidence linking our product to this adverse event) are shown to be unreliable. This confidence conundrum often has a polarising effect and significantly raises the stakes.

The second rule of engagement is avoiding the data dilemma. This rule speaks to our over-reliance on numbers that are often too nuanced to decisively settle a medical debate. And because questions of safety can linger until much more is known, it is unlikely that authority will ever settle the question in the short term.

Whenever such questions emerge, we should focus on patients rather than numbers (especially in the face of negative news), construct arguments based on what we know for sure about a brand, and pledge to learn more about what we don't know.

The third rule of engagement is private is public. Information, by nature, is porous, sometimes partisan and, thanks to today's technology, it is easily distributable. Characterising in the press what others have said privately to bolster one side or the other takes on the air of political theatre and moves the argument out of the scientific realm. This is never a good development for science-based businesses.

The fourth rule of engagement is prepare for the macro key ie the news paragraph that becomes embedded in every subsequent story about you. Think of it as the boiler plate in a news release, but judgemental. It describes your outcome in the argument. Every time the story is refreshed by another reporter or reference is made to the company, the macro key inserts a paragraph describing your situation (eg, company X was forced to pay... brand Y was found to cause...).

Pharma communicators should always have their eyes on what they want the macro key to say before it is written, since it is the macro key that speaks loudly and often on matters of reputation and trust. Reputation and trust are never only about a brand but always involve the company and its executives.

A mutual gains approach
Since public trust is so important, when questions about science and authority arise, pharma should consider a different approach to conflict resolution. A mutual gains approach to resolve issues might be a more appropriate model. By acknowledging the concerns of others, focusing on building long-term relationships, and sharing power or offering contingent commitments to minimise impacts, a mutual gains approach could reduce the heat and restore a level of trust in our industry.

We spend too much time telling people what we want them to hear rather than what they need and want to know. Rarely has the industry embraced a mutual gains approach in these high stakes situations, and that decision may have resulted in the unintended consequences of isolating the industry from its customers and other stakeholders in the healthcare system.

From claims to conversation
By understanding the rules of engagement and the value of a mutual gains approach, we just might improve our ability to navigate turbulent waters. But it is also helpful to understand why such scepticism and cynicism exists towards the industry.

Pharma communications rely heavily on science and authority to deliver information to doctors and patients. We promote medical claims authorised by health authorities and build equity in a brand around a body of evidence and beliefs. But science moves forward, challenging what we know about brands and making them more valuable or more vulnerable. It is the vulnerability of brands we need to address in order to avoid the clash and improve trust.

Until just recently, most direct-to-consumer ads have promoted claims with an air of confidence bordering on infallibility. Ads are often powerful and convincing, but only occasionally do they spark a conversation among doctors, patients and families.

In today's world patients expect and need a conversation but often don't know what source to trust.

Public relations draws audiences into a conversation, providing perspective on a disease, comparing and contrasting treatments, suggesting appropriate behaviours, and often providing first-person insights to support a point of view. Admittedly PR can be biased but, when done well, it can also educate, inserting a discussion about the benefits of treatment, without referring to a specific brand, to make patients more confident in their medicines when faced with scary news about risks.

PR can provide perspective on issues or arguments, which makes it a logical choice when science and authority tangle. But it's equally important to recognise when not to tether PR too closely to certain types of branded messages that can undermine its effectiveness.

Pharma has used both these powerful tools – advertising and PR – to communicate branded messages to good effect. But it has underestimated and under-utilised the power of PR to shape attitudes and behaviours about itself, and over-utilised advertising to deliver messages about its brands. This reliance on the brand message, particularly in the consumer marketplace, has hurt pharma's reputation – the entire world doesn't care about a brand's message, but it does care about its ethics and behaviour.

The reliance on advertising also reflects a belief in the value of controlled, branded content and a certain unease with the less controlled conversation commonly associated with PR.

If advertising is what you say about yourself and PR is what others say about you, PR may be less reliable at delivering brand mentions, but it is infinitely more credible. If trust is the number one problem facing the industry, credibility is the best medicine to cure it. Yet pharma has not unleashed its most effective tool, nor changed the way it argues conflicts when they occur between science and authority.

Pharma continues to act as the repository of science and the voice of authority on its own behalf but to its detriment. More than ever, as the industry and health system landscape continues to change, pharma needs a conversation with its customers and stakeholders. It seems particularly important at this time when powerful forces reshaping the fundamentals of the business require us to think differently about our place in the universe.

Just as policy-makers and payers will play an increasing role as customers, patients too will be more important, especially as they pay a growing share of the cost of healthcare and seek better ways to stay healthy for longer.

Opportunities lie ahead
Are patients likely to look to pharma for information or run to other sources? I suppose it depends on their level of trust in the industry and the offerings we provide. A new landscape for pharma presents an opportunity to do what marketing health products has always been about – reach doctors and patients with meaningful products, information and services, and encourage healthy behaviours.

Only by avoiding the vulnerabilities inherent in authority can we protect our reputation and establish a meaningful conversation with our customers again. We are making inroads, but we might just need to embrace a mutual gains approach to the problems and apply it more broadly than just when we're confronted by a crisis.

Many in the industry believe we are not aggressive enough in getting our stories out there. The larger question may be: what stories should we tell?

The Author:
Richard Chamberlain is president of Chamberlain Healthcare Public Relations

29th October 2008


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