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Secrets and lies?

The industry has long been mistrusted, but is it possible to improve its reputation?

The pharmaceutical industry is one of the largest industries in the world and yet, it is not always viewed by the general public as a source of trusted information. Unsurprisingly, it's doctors who often top the `most trusted' lists. Where there is research from the ABPI to show the industry's reputation is `improving', there is little to show this has increased the trust of the nation (including healthcare professionals) in the information provided by the pharmaceutical industry.

Earning trust
For many who work in the pharmaceutical industry this lack of faith is bewildering. But for others the reason is clear - they believe the industry has forgotten a key element of earning trust among its critical stakeholders - that of communicating with them about what they are doing, and why.

Rob Wood, the sales and marketing director at AstraZeneca believes that in this respect the industry has let itself down.

The code is a bit of a red herring as it has been around for years. There's been a general lack of promotion about what the industry does. We need to educate the public about the benefits of having an active pharmaceutical industry, Rob says. For example, if there's a positive item about a fall in death rates from breast cancer on GMTV, the praise goes to an improved NHS and we never get a mention for the work we have done in researching and developing those drugs.

While the general public views the pharmaceutical industry with mistrust, healthcare professionals look on with polite cynicism.

This is partly our fault, says Rob. We have raised doctors' expectations about what to expect, particularly in terms of hospitality. That said, the medical profession isn't totally blameless as many haven't pushed back.

The industry has always been concerned about its reputation, but quite rightly devotes most of its time to abiding by the rules of engagement as laid down by the pharmaceutical industry under the umbrella of the ABPI.

The spirit of the code
Self-regulation is a worthy concept applied within the industry for years - and taken up wholeheartedly and with great seriousness. But there is a huge amount of 'grey' within the code that allows the industry to put its own interpretation on many elements, particularly communication.

But surely it is the spirit of the code that is its essence? The problem at the moment is the game playing - everything is fine so long as everyone is playing within the rules as defined by their own company's interpretation of the code.

The ABPI has worked hard to publicise the changes to its Code of Practice, including the first national 'code day', but was this enough? And did we, as an industry, do enough to support them? What about the stakeholders that the code day didn't reach? What about journalists, nurses, pharmacist and policy makers that we speak to every day?

NHS commissioning specialist Tim Jones says: I have absolutely no clue what the Code of Practice is - I only know I am rarely able to access the relevant information I need from the pharmaceutical industry.

The code exists to ensure that the industry doesn't let the patient down, by misleading them or allowing them to interpret data themselves - something for which they are not qualified.

At the same time, the industry has a job to inform and educate the public about therapeutic areas and scientific breakthroughs. The code needs to remain flexible enough to allow communication through the media - at the moment, there is a danger of cutting off this vital source of education by, for example, scrutinising the use of case studies.

Ironically, if in the future the industry is unable to supply journalists with patient case studies when requested, it is the patient who will ultimately lose out. Journalists and the public see case studies as the most engaging way of illustrating how a disease can affect someone's life.

Be positive
Everyone who works in healthcare communications carries a huge responsibility along with them - the health of people. We should all be pro-health, not just pro-industry.

And we should be positive. What's happened to our pride in what we do and achieve? During awards season, some pharmaceutical companies were cautious about entering their work and some made a corporate decision not to. Sometimes these decisions are necessary, particularly given the number of complaints in the system.

However, as we move forward we should be loud and proud about what we do in communicating health messages. If we are nervous about a complaint, then surely we shouldn't be doing it in the first place?

Communication is key
The place of communications is central to the reputation of the pharmaceutical industry as we continue to communicate health messages to both healthcare professionals and the general public.

As Diane MacArthur, the communications manager at AstraZeneca says: The spirit of the code is clear, but its implementation in practice in some areas isn't fully defined. We need to work in partnership with all stakeholders - healthcare professionals, journalists, patient groups and commissioners - so they can understand why we behave in the way we do and ensure they are engaged in the processes we put in place. The code has been applied and very little context put around it.

We do, however, have a situation where code breaches receive publicity and there is a focus on isolated incidences within a wealth of excellent work that we fail to promote.

Guidance is needed about how to implement each section of the code and in order to get greater cross-stakeholder communication and understanding. The Healthcare Communications Association has made a start down this route with the soon-to-be-launched Best Practice Guide.

Best Practice Guide
Appropriate rules, regulations and codes of practice are all important in helping ensure that the pharmaceutical industry operates to the highest ethical and professional standards. However, we will all ultimately be judged by how we implement our activities in practice within these frameworks. The Healthcare Communications Association's (HCA) overall mission is to provide an independent forum to drive the highest standards and promote best practice, innovation and excellence in healthcare communications.

A special HCA committee, made up of individuals from member organisations, is busily working on an HCA Good Practice Guide. The first part should be unveiled early next year. Practically, it has been agreed to break it down into discrete topics, starting with one that is arguably the highest profile - working with the media. Within each Good Practice Guide (which will be web-based) the approach is to review what all the relevant regulations and codes say about different activities, consider that in the context of existing case law and then clearly lay down practical recommendations for anyone communicating about health and medicinal products. It's a long job, but a pivotal one in the big picture of enhancing the reputation of the pharmaceutical industry and its practices.
Julia Cook, chair, HCA

But all this is against a background of bias within the healthcare community. A study published recently in JAMA found acceptance rates for non-industry versus industry studies were 41 per cent versus 29 per cent under open review and 34 per cent versus 29 per cent under blinded review. In other words, the acceptance rate for non-industry studies increased when reviewers were un-blinded, whilst support for industry studies stayed level.

Self regulation
So, in an atmosphere of mistrust and bias, how public should breaches of the code become and what effect do they have on healthcare professionals and their patients?

David Impey, the European marketing director at Eisai, believes that the pharmaceutical industry must ensure self regulation doesn't become self flagellation.

We are in danger of losing the trust of doctors by not engaging with them and we need to invest in the relationship-building skills of our reps. David continues: What we do is not that different from doctors - we are just the tool makers for the mechanics of medicine. We all take responsibility for the welfare of the patient.

Perhaps, ultimately, it's the patients who should decide.

As Rob Wood says: We need to go to the public in an organised way and have a relentless public education campaign around the benefits that the pharmaceutical industry brings to the health of this country.

Working together
Hearing about the distrust of both the general public and healthcare professionals when the PR and medical education industry's job is communications, is totally frustrating. Both lay and medical journalists have neither little idea nor any interest in the ABPI Code of Practice and what it contains. Why should they? Their job is to report the news, not to report on how well referenced that news was, or whether the meeting was held in a three- or four-star hotel. Unfortunately, the only 'news' we give them is the latest code-breakage.

As David Impey put it: No one hates us as much as we think they do. Now is the time to act - and to act together.

The author
Catherine Warne is the managing director of Red Door Communications. She can be contacted at cwarne@rdcomms.com

2nd September 2008

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