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Melting away

Why has pharma's international image been eroded away so severely, and what can companies do to turn things around?

What is it about the global pharmaceutical industry and its work that imbues it with such a poor public image?

Is not the core raison d'Ètre of the pharmaceutical industry to discover and develop vital new medicines? Is it not an industry whose entire business is based on the betterment of society's health, and which aims to help people who are ill and improve the lives of those who must suffer chronic illness? Is pharma not run by compassionate human beings, many of whom admit, openly, that the best parts of their job are the few snatched moments in which they meet people who have been helped by their products?

Pharma is all of these things and more. Understand it and respect it; don't understand it and don't respect it. It is an industry that spends its time promoting good life, and yet it struggles to shake off a reputation better suited to an escaped prisoner.

It suffers continuous criticism from a censorious public. The media jab at every pressure point with sharp headlines and, sometimes quite inaccurate, scathing reports. Governments are suspicious of an industry so seemingly altruistic, yet which can make so much money, no matter how risky the business of developing drugs is in actuality.

Surely people cannot deny a business making money, otherwise how could it exist and provide a place of work for hundreds of thousands of normal, everyday people? Surely people can understand that if you do not sell today's medicines, and attract other investments, you will have no money with which to seek out tomorrow's medicines?

It is time to move the discussion on. Pharma companies around the world are well aware that they are, sadly, seen as sitting just one place from el Diablo himself at the table. They are his right hand man, but there is no point crying over this situation. Whether they like it or not, pharma companies need to pay greater attention to their public image. Until they do, an unfavourable air will continue to hang over their every move.

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What to do?
Is it time to get serious about improving the public image? This question was raised in a discussion panel recently at the 2006 PharmaBrand Europe summit, in Monaco. The answer is probably `no'. That is, `no, it was time to get serious about this issue before now'. However, we must also admit that `yes, now must be the time' to start turning things around.

The first sticking point is that there are no obvious actions that might help but which many, if not all, companies are not already undertaking. Today's pharmacos not only have responsible policies, but the vast majority also go above and beyond the daily grind, making an extra effort to act in philanthropic ways.

Support for the arts, educational grants, technology transfer, price reductions for developing countries, charitable investment in human endeavour around the globe and so on. But none of it does much, if anything, to appease the critics, who claim that pharma is merely attempting to `be seen to be doing the right things', and in fact does not care one iota for anything outside the hoped for PR benefits of these activities.

There's no question that there is an overwhelming negative vibe, but I think probably the area where we, as an industry, have not focused enough is on discussions about the patient, Rich Pilnik, group vice president and chief marketing officer for Eli Lilly & Co, told delegates at the PharmaBrand session.

We talk about the disease, we talk about the brand, we talk about the company and then, maybe at some point, we eventually get to the patient.

Rob Cohen, European communications director at MundiPharma, agreed with this principle, though was more fervently critical than Pilnik of pharma's apparent oversights. We allow ourselves to get carried away with the commerciality of what we do. By and large, I perceive us to be pretty good; the problem is we are architects of everything that falls at our feet. Everything we do has to be done, more than any other industry, for society, at the behest of society and paid for by society - and currently we don't view things in that way. We have shied away from the issue of image and we haven't done nearly enough to address the thinking on street level of how people view our industry. Much more effort has to be put in.

Head of excellence at Novartis and chair of the discussion panel, Martin Armstrong, asked whether, in that light, pharma was guilty of thinking in marketing terms, purely on a product basis, and not really putting `its money where its mouth is'.

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Cost-innovation disconnect
During the session, which took place early in June, one delegate in the audience proposed that there is nothing more international pharmacos can do to improve their reputation with the public than simply deliver on their promises of innovation.

You could say that, in some respects, this argument is fair but also flawed, as when pharma has successfully managed to control or even effectively eradicate diseases that in the past tore through society, its contribution has been taken for granted.

Yet, this pharma delegate felt that the public could not make the connection between the `high costs' of many medicines, and the return on this investment in terms of innovation. I think the main problem the pharma industry has now, and this is why its PR is so poor, is the seeming lack of innovation. We bring to the market drugs that are not as good as some current drugs already on the market, but because they are `new' drugs they have a higher price. If the pharmaceutical industry brings real innovations, then we can ask for more money.

His challenge to the panel was that the poor reputation was down to an innovation-cost disconnect. This year, so far we have made record profits and people wonder why we're asking for even more money for our newest products. Of course, we can't give everything away for free, but if we bring more innovation to market, are more ethical and sensitive in the way we report our profits by putting them in a clearer context, and if we tackle issues in Third World countries in a better way, then I think our image will improve. If we just keep delivering drugs that are not really new and asking ridiculous prices for them, then our image is going to go down and down.

Mundipharma's Cohen was keen to acknowledge these points, but he queried the extent to which pharmacos could do more than they do already to address the problems.

I accept everything you have said, but clearly we cannot `invent' innovation just like that. It is not quite as simple as coming up with brand new, world-class drugs - if we could do that, we would do it. Nevertheless, I do think that time and effort that is spent on other, extraneous activities, could be better spent focusing on discovering and bringing to market those new, real innovations.

On the not insignificant challenge of ensuring that developing countries have easy and affordable access to modern medicines, the panel expressed some unification around the narrative that pharma companies operate in a commercial, economic structure that they cannot avoid.

We know that we will run into issues if we start doing some of the things that people are asking of us, commented Cohen.

Having said that, I think that we simply do not go far enough. We need more integrated policy as an industry, and as a group of companies, towards helping these countries.

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Do drugs and money mix?
A fundamental point in the debate about pharma's image problem is that, in the public's mind, there is a question mark hanging, like the Sword of Damocles, over the practice of making money out of healthcare. It is seen as something unethical and undesired.

Today, many European pharmaceutical markets face shared challenges. People are getting older, there are fewer payers into the healthcare system and governments are driving through cost-containment measures vehemently.

Departments responsible for maintaining and improving health, however, have issued clear targets on reducing the number of deaths from cardiovascular disease and cancer, controlling diabetes and cholesterol, anti-smoking and many more.

People are expected to keep good health, and be aware of how to achieve that, but there are tough price controls and unmovable obligations on medics regarding generic level prescribing. As blockbusters lose patent protection, pharma is being asked for more but must deliver with less, and people want to see giant leaps forward.

In our lives we are used to paying for innovation, another PharmaBrand delegate noted. When I buy an iPod, I get innovation I can see. In the end, we are all measured by our sales; our companies make profits and we get bonuses, which is great, but I think in pharma we are seen as greedy because people can see the money but it's not so easy to see us delivering the innovation.

Signs of anti-trust?
A theme that reared its head, and not for the first time when pharma executives get together to debate, is the value and role of the industry's representative associations.

There was a mild incongruity between Lilly's Pilnik and Mundipharma's Cohen over the helpfulness that EFPIA, IFPMA and other industry bodies imbue. In essence, Pilnik was more openly complimentary, while Cohen revealed that he felt let down by the lack of proactive communication and outreach from the associations with regard to involving pharma ardently in debates about its activities, and particularly in response to criticism.

Clearly the message is not getting through [to newspapers and non-pharma circles] of the positive societal role the industry plays. Add to this, in arguably our time of greatest need for improved trust, the industry bodies turn around and deliver new codes of conduct that basically say `you can't be trusted'. This to me is hugely frustrating because you try to get this message across but they are stopping you from doing it.

A member of the audience, from an international biotechnology company, added that employees would all probably wish their neighbours and friends knew and appreciated the work they do as pharmaceutical marketers, but pragmatically speaking, if we go to see the CEO and say `we want to improve the public image of our company, and the pharma industry', the first question is going to be `is there a business case in place'?

In essence, it will cost money to do it and the CEO must know what the return on investment will be because he may need to justify such a decision to the shareholders later down the line.

So what can we take from this debate? How is pharma to regain trust and positive recognition from the public?

Perhaps the answer is to be more careful about the light in which companies might cast themselves: ie, a more subtle approach to announcing profits and more time and effort spent on talking about the patient, which perhaps should always be at the centre of any public healthcare debate.

However, it probably remains that pharma's way out of its largely undeserved image troubles is simply to keep doing its job. Regardless of extra philanthropic actions companies might undertake, ultimately people will only bring firms to mind for the quality, safety and accessibility of their therapeutic innovations.

Pharma's primary responsibility to society must be to continue to discover, develop and, in partnership with governments and other parties, bring to market new and effective medicines. Given time and a few proactive steps towards focusing more openly on the patient, perhaps this aim will re-emerge in the minds of the public.

The author
Rob Skelding is the editor of Pharmaceutical Marketing Europe magazine

2nd September 2008

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