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Marking your territory

Purists have been keen to mark out a safe swimming zone for medical education but is the discipline in danger of being dragged under by a PR rip current?

It's enough to ask just exactly what is medical education? to get the most seasoned of pharma sector campaigners furrowing their brow in concentration as they ponder the question.

It's little wonder why, as trying to pin down a precise definition of med ed is akin to trying to locate one of those irritating under-the-skin itches that never seem to subside despite the most frenetic of scratching. In the all-important US market, the term `medical education' is tied to accredited continuing medical education (CME), which is clearly distinguished from other forms of medical communications. In the UK, the term can be used as a broad umbrella for an array of early-stage communications and educational activities designed to build up the requisite amount of disease awareness among key opinion leaders prior to product launch.

Med ed purists would lay emphasis on the altruistic aspects of the discipline and distance themselves from any overt promotional considerations, but the majority of agencies offering med ed services will accept that their efforts constitute an early component in the overall project to build a brand in the minds of physicians.

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Another reason why it is so difficult to define med ed is that the discipline is constantly evolving. Initially springing out of isolated projects which companies felt could be adapted to start building beneficial communications during the early stages of product development, med ed developed into a whole new process of communicating brand attributes to the right medical audiences. It proposed a win-win situation for both pharma firms and the medical community; the former could begin to generate noise and anticipation in certain disease areas before the PR machine kicked in, while health professionals could start to learn about the potential benefits of new working tools long before they became available for use. Always with an emphasis on scientific integrity and a watertight peer review process, med ed continued to thrive.

A Blurred picture
These days, however, the picture has started to fuzz around the edges. On one side, contract research organisations have staked a claim to the med ed pie by offering evidence-based strategic medical communications based around their clinical trials. Further down the drug development line, PR firms have been trying their hand at med ed for a good few years now, and many of them, much to the horror of the purists, have managed to carve out a `specialist' reputation among well-paying clients. To all intents and purposes, the term med ed appears to be dying out; `strategic medical communications' is the much more popular and probably more appropriate description in today's environment.

On the face of it, such a move seems to make sense. Advocates of bringing PR and med ed closer together say there is a compelling argument to dismantle the `silo' mentality and start to integrate hitherto separate communications activities for the sake of the all-important brand. However, there are also those who believe that, like oil and water, the two don't mix well.

Jane Jones, publishing director of the Medical Education Partnership, describes her agency as a specialist med ed company and is keen to draw a distinct line between the educational and altruistic work she claims it does and what many PR firms in the UK are now offering. She believes that PR companies can integrate med ed into their range of services as long as they recruit the right people and recognise the special nature of med ed, but adds that many simply do not do this.

I believe a lot of PR companies blur the distinction and it would probably behove them to look at the differences and see the additional opportunity, she says. Initially, I was irritated a few years ago when PR firms came in and started offering something that they labelled `med ed' but which in my opinion wasn't - it was promotion.

She continues that while she does not blame PR agencies for jumping on the med ed bandwagon she is often irked that many have diluted the essence of med ed with extravagant claims and an overly-promotional approach.

Some [PR firms] come in and promise a whole load of things that we don't promise, she explains. They will mention the drug name, while we actively don't allow ourselves to do that. As far as I understand it, PR should come in at the stage where stakeholders need to know about the drug, whereas we're more into educating people about disease areas and what is available in those areas. The two are separate educational services.

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Drawing the line
Drawing a clear line of distinction between PR and strategic medical communications is a tricky thing to do, and not worthwhile according to Viv Adshead, group managing director of the Gardiner-Caldwell Group.

All said and done, we're a service industry and we're about supporting our clients in the way they see as appropriate, so for the industry to come out and draw a line would be artificial, she states. We all have to adapt - it's a constantly changing environment and we operate in an open market.

Sean McGrath, managing director of Succinct Communications , describes strategic medical communications as the whole activity based around managed entry and market access that takes place before product launch into the UK market. He is adamant that this is extremely specialised work and admits to being frustrated at PR companies that believe they have the nous to do it.

Once you have a licence and have been through NICE, you have to answer questions such as how the product is going to help the NHS achieve its goals, how it is going to help patient flow and waiting times, and what the impact will be on any service delivery, he says. PR firms cannot do that, it's just not their remit. Some PR executives who are great at PR suddenly think they can do med ed, just because they've put together an advisory board and taken some notes. They will say that they are capable of doing the whole managed entry and market access activity but they don't even know who to speak to. Unfortunately, a lot of them think they can fulfil this function, and we often end up picking up the pieces.

McGrath believes that PR firms simply don't have the scientific expertise and acumen to run a strategic medical communications initiative effectively. Once you start getting into the nitty-gritty of the disease and the science, they are lost, he says. Their background is in terms of working with the media and to some extent, working with patient groups but putting together a speaker's bureau for a launch meeting in rheumatoid arthritis is beyond them. They'll either do it badly or without any depth.

To find the evidence of how well ensconced the PR fraternity is in delivering its own brand of medical communications, one need only speak to international med ed firms. Adshead says that her firm tends not to do a lot of work in the UK because most of the work that we would normally consider medical communications is done by PR and advertising.

She explains that the message from UK clients is that if they are going to prioritise spend, they are much more likely to do so on advertising and above-the-line promotions.

A lot of what we do internationally is more strategic and certainly isn't in those kind of areas, she says. We have done UK work in the past but I guess the way we work isn't the way UK clients find useful.

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Scales tipping towards promotion?
The proliferation of PR firms offering med ed services has led to criticism that the scales are tipping more towards promotion rather than education, but even the most ardent of med ed purists would argue that commercial considerations have always been high on the checklist when drawing up a programme. After all, companies would not fund a medical education initiative if they didn't think they were going to profit in some way from associating themselves with it.

Jones at the Medical Education Partnership accepts that, as an early form of brand communication, med ed does have commercial overtones: When a company sponsors medical education, it is getting its name in front of doctors without any blatant promotion of products.

McGrath says that many people fail to see that education is promotional, albeit in a more holistic way, and towards the company rather than the product.

Whatever medical communication is happening and even if the programme is being run in the most professional, unbiased and purely educational way, the company paying almost always wants to be associated with it, he says. They want that association with the disease area so that when the product does launch in a year's time, they already have some presence. Medical education is promotional in this sense, but the crux of the matter is that the education has to be unbiased and that's the difference with PR.

Measuring the return
Companies are also increasingly keen to see evidence that they are receiving a return on their investment (RoI) when it comes to med ed.

In the CME arena, as Adshead points out, the only return that is appropriate to measure is tied to the quality of the education because the moment it is linked to any revenue gain for a pharmaceutical company then it undermines the fact that the education is unbiased and not under the influence of industry.

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The issue of performance evaluation in strategic medical communications has long been a sticky and nebulous subject, but there are signs that agencies are starting to deliver concrete, meaningful methods of measuring the benefits of their service offerings. Some are finding paths to successful evaluation through work with the NHS. McGrath explains that in many areas, the NHS is very keen on measuring and auditing, and is often very happy to allow third parties to do the donkey work for them. He says that in the area of prostate cancer, the pick-up of chemotherapy as a treatment for the disease is very slow because the management of patients suffers from a lack of communication between urologists and oncologists. His firm offers Trusts and cancer networks assistance in implementing mandatory Improving Outcomes Guidance (IOG) and will measure teams of oncologists and urologists in how successful they are in doing this.

The outcome will be increased sales of chemotherapy drugs, and that can be reported back to the client, he says.

Adshead believes that on a national level, it is easier to get a handle on the effect of a medical communications initiative: You can watch sales trends and see the impact a new programme has had on the product you're assisting with. It's on the international stage that this becomes more difficult as there's no direct link between the work you're doing and the prescribing base.

She adds that her firm offers to put in place performance metrics so that clients can at least get a sense of how they're benefiting, although she admits it is still often difficult to put a dollar value on it.

Dusting down the crystal ball
Those brave enough to dust down their crystal balls and try to predict what the future will hold in store for medical education will no doubt recognise the trends of consolidation and integration that are sweeping through the industry at both client and agency level. Agencies are very keen to offer a wide range of services and `integrated healthcare communications' has become the popular umbrella phrase that firms are using as they begin to compile PR, med ed, advertising and branding solutions. Huntsworth Health's merging of its medical communications, advertising agencies and brand consultancy under one brand name is a recent example.

McGrath says that such a proposition is extremely workable as long as the divisions are kept separate. He describes his own firm's search for a PR heavyweight to run its new PR division as a recognition of the value of PR and insists it will be distinct and separate from the healthcare communications team.

PR's increasing influence and the name-tag switch to strategic medical communications could be construed as portentous for medical education, but nobody is predicting its demise.

Even if elements of the marketing mix do come together under one banner, there's still a perception in many clients' minds that each one requires a specific skill set, notes Adshead. Clients enjoy the comfort of knowing they are working with specialists rather than generalists. I think there will always be space for med ed agencies that specialise, because for some clients their proposition will be the be all and end all.

The Author
Gareth Carpenter is assistant editor at Pharmaceutical Marketing

2nd September 2008

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