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what is public relations?

Investment in public relations by the pharmaceutical industry has increased substantially over the last fifteen years. What was once regarded as a 'luxury' if there was enough budget to run to additional activities is now very much front of mind for most pharmaceutical companies when they are planning and executing their marketing activities.

Investment in public relations by the pharmaceutical industry has increased substantially over the last fifteen years. What was once regarded as a 'luxury' if there was enough budget to run to additional activities is now very much front of mind for most pharmaceutical companies when they are planning and executing their marketing activities.

So why is a well planned public relations programme important and how can we measure how effective it has been against all the other disciplines in the mix?

There are various definitions of public relations that can be found in dictionaries, on websites and in books. The Chartered Institute of Public Relations defines PR as 'the planned and sustained effort to establish and maintain goodwill and mutual understanding between an organisation and its publics'.

So what does that mean to
pharmaceutical brand management? Defined in its very simplest terms, PR is 'third-party endorsement'.

Third-party endorsement

The benefit of third-party endorsement can be seen in all aspects of our lives. Most people would be very unlikely to purchase something just because they have seen or heard about it once. However, they would be much more likely to purchase it if they had already seen or heard about it and decided that they would quite like to buy it. Then on hearing someone who they respect endorsing the item, saying how pleased they are with it and listing its features and benefits, perhaps even giving examples of the positive impact that it has had on their life, they would be infinitely more likely to make the purchase.

Celebrity endorsement takes this to another level. Sienna Miller has only to walk to the corner shop with the latest Chanel handbag slung over her shoulder in order to send a stream of women rushing out to buy one just like it, generating a waiting list of months if not years for this coveted possession. Likewise, after Delia Smith endorsed several of Sainsbury's products on her TV show 'How to cook', the store sold out of whole ranges across the country.

Both of these examples illustrate the impact of promotion where a respected individual has made a personal choice regarding the brand that they prefer
to purchase.

Therefore, the basis of any successful public relations plan is third-party endorsement.

Promoting to target audiences

Public relations falls under marketing, of which there is also a wide number of definitions. However, all marketers are familiar with the concept of the marketing mix and its constituents - most commonly the four P's - price, promotion, product and place. Public relations sits under P for promotion and is one of a number of methods used by marketers to communicate with their 'customers.'

In some branches of PR, promoting your product may often be as simple as ensuring promotional banners are in place at sporting events, conducting sampling in shopping centres or obtaining celebrity endorsement. In healthcare PR it is not quite that straightforward - direct promotion of prescription pharmaceuticals to consumers is illegal but disease awareness campaigns are allowed as long as they follow the guidelines set out by the Medicines and Healthcare products Regulatory Authority (MHRA).

Customers also fall into three distinct audiences:

  • Consumers - patients, their families and friends
  • Healthcare professionals - an expanding group of individuals prescribing and making decisions about our healthcare
  • The media - print, broadcast and online in both consumer and medical sectors.

The rules are slightly different whether the medicine is prescription only (POM), available from a pharmacy over-the-counter (P) or available for general sale (GSL). However, when promoting to each of these audiences, marketing activities are quite rightly governed by strict codes of conduct issued by organisations such as the Association of the British Pharmaceutical Industry (ABPI), the MHRA and the Proprietary Association of Great Britain (PAGB).

When medicines have the potential to change a person's biological function, a company must market its products responsibly and ethically to ensure that its customers understand clearly when and where its use is appropriate. This means that an agency working on behalf of a company must also adhere to these codes of conduct. If the agency makes a mistake, it's the pharmaceutical company's reputation that is at stake. Healthcare is an emotive area and care must be taken not to raise false hopes about medicines and treatments. Knowing the relevant codes of practice is essential for anyone working with the pharmaceutical industry.

As well as strict codes of conduct to abide by, healthcare PR has more challenges than most in helping its clients communicate often complex concepts and information about their products.

Why do PR?

Public relations is one of the most powerful tools in the promotional mix and used wisely it can deliver impressive results. It is most often compared with advertising and is, in some cases, still evaluated against equivalent advertising spend. Although this can be a useful demonstration of value for money, it fails to take into consideration the value of the most important aspect of good PR - third party endorsement.

However, each type of promotion has its pros and cons and it is up to the brand team to decide how their budget will be best spent across the promotional mix. The skill is in bringing the various disciplines together to achieve the brand's objectives. With PR, outcomes cannot always be guaranteed. So if you have to deliver an important piece of information and there must be no doubt that your audiences have received it, then direct mail may be more effective than both PR and advertising. For example, a 'Dear Doctor' letter.

Once the decision has been made to undertake a PR programme, the next challenge is ensuring that it is a success. Perhaps one of the most important things that you could ask all parties involved at this point is what they think success will look like. It is really useful to gain people's views because success can look very different from person to person.

So what are the key things you need to be aware of in order to ensure the success of your campaign?

The survivors' guide to PR

Imagine that you are one of four people stranded on a desert island. There is no other land in sight and no possible means of escape. After some time a boat arrives on its way to habitation, but there is only one spare seat and there is no way that it can possibly take any more. The owner of the boat offers to moor up at your island for two days to allow each of you to show him why you should have the last seat on the boat. At the end of the two days he will decide who gets the seat. So how would you do it? How would you construct your PR campaign to ensure you were the most popular choice for that seat? Essentially, what are the stripped down, bare essentials of public relations that you would need in order to deliver an effective PR campaign in any situation - your 'survivors' guide to PR?'

Survival tip one - know your market

Solid research is the basis to a good PR campaign. A thorough understanding of the current market place, competitor products, influences and areas of opportunity can often set you apart from your competitors and help to ensure the long-term success of your PR programme. A benchmark of where you are starting from is really important when thinking about how you are going to measure the success of your PR programme.

Good places to start your research are sales data, journals, patient groups, the internet and telephone research among customers. Also ask around and find out what resources already exist within the company. Research may be ongoing to which you could add a couple of questions rather than commissioning your own expensive market research project.

Pulling together a PEST (political, economic, social and technological analysis) can help to build a clear picture of the market place. Your PEST could include, (among others):

  • Relevant treatment and disease area guidelines from relevant professional associations and bodies such as the Royal Colleges, disease specific societies, NICE, etc
  • An overview of interested parties and their influence, for example, relevant patient and professional groups
  • An analysis of competitor products and activities focusing on strengths and weaknesses of each
  • A review of which medical professionals are involved at each stage of care.

Although positioning work is conducted separately from the public relations activities, it's important to consider the positioning of the brand as it will affect the way that you construct your PR programme. Using the information you have gathered and your existing knowledge of your product you will be able to develop a simple SWOT analysis identifying your products strengths, weaknesses, opportunities and threats in the current climate.

Back to the boat - in order to ensure your success you will need to know a bit of background information - who influences the captain? Who are your competitors? How are they likely to react to the current situation? What strengths do you have on which you could play? Are there any rules and regulations on the boat that you will need to abide by? And perhaps most importantly, what is the situation on board? Better to do your research in advance than find out that the boat is actually out of food and you will be lucky to get to habitation before you starve!

Survival tip two - know your audience

In every PR campaign it is important to know and understand your audience in general and in relation to what you are promoting. For both of these situations, you need to consider each of the audiences to which you are promoting as their needs are likely to be different. Patients may prefer to receive information in a different way from their doctor, and nurses in a different format to pharmacists.

Use the background research you have already gathered to develop a list of your target audiences. A thorough approach to developing an understanding of how they think and feel is to then conduct interviews with representatives of each group. Questions you should ask include:

In general:

  • How do they like to receive information - printed, by email, as a presentation, face-to-face, over the telephone, via text?
  • Where do they go to find information - newspapers, trade press, magazines, internet, colleagues, family, friends?
  • When is the best time to contact them - time of day, day of week, at home, at work?

In relation to what you are promoting:

  • How do they feel about the disease area - what is the likely reaction when given a diagnosis/giving the diagnosis?
  • What needs are required to be met by a new treatment?
  • What is the preferred mode of administration of a treatment?
  • How would they feel about a treatment with similar properties to the one that you are promoting?
  • How would they be interested in finding out about a new treatment, at a conference, through medical literature, via a sales representative?

In our current boat situation your audience is the boat captain, so a little bit of research will help to raise your game. Finding out from the crew the best time to speak to the captain, whether he would prefer a face-to-face chat or a proposal scrawled on palm leaves and finding out what he is looking for in a new crew member will all give you a competitive advantage over your fellow island residents.

Survival tip three - setting objectives

Most people have heard of SMART objectives (specific, measurable, achievable, relevant and timed) but they are not always used. Setting SMART objectives at the outset provides a clear and simple means of measuring whether your PR campaign has actually achieved what you set out to do.

Setting objectives is all about where you are now and where you want to be.

You should consider overall objectives for your campaign as well as objectives for specific activities or audiences. For example, if a key part of your PR campaign revolves around a specific event such as a conference, one obvious objective would be to achieve attendance of a set number of delegates at that event. For example:

  • Achieve attendance of at least 150 medical professionals from our target customer list at the company's satellite symposium at the UK's leading conference in June 2007.

You may then want to include objectives specific to your target audiences,
for example:

  • 80 per cent of the nurses attending the conference rate the content of the event as good or excellent.

You may want to consider broader objectives for the whole campaign,
for example:

Ensure that product X is on at least 75 per cent of hospital formularies six months after launch.

It is not wise to have too many objectives. SMART objectives are achievable and if you set yourself too many you are unlikely to achieve them all. Also, although most of them will be set around short term outputs, there should be some longer term ones too that tie into the overall brand objectives. Be clear about what you want and stick to it.

Going back to the boat again, your SMART objective here is pretty simple - to ensure that you are 100 per cent successful in securing the last remaining seat on the boat before it leaves in two days time!

Survival tip four - strategy

After your thorough research, familiar-isation with your target audiences and setting your objectives, your strategy should already be evolving.

While objectives are about where you want to be, strategy is about how you are going to get there. There are many factors that influence a strategy and these will vary across the lifetime of a product. What is the right strategy at launch may not be the right strategy one year on, not least because you may have met some or all of your objectives but also because the market may have changed - new treatment guidelines may have been published, newer medicines may have arrived on the market or generic competitors may have been introduced. Both objectives and strategy should be continually monitored to ensure you are still moving in the right direction and that your aims are still realistic.

There are a number of strategies that could be employed to achieve your objective of securing a place on the boat but it will be your effective research that will ensure you choose the right one. For example, a good strategy would be to convince the captain of your value as a crew member by demonstrating your skills as a chef. However, if Gordon Ramsay is recovering down below from last night's dinner service then you are unlikely to succeed in your objective! A better strategy might be to offer your excellent services as a counsellor to all the dejected galley slaves!

Survival tip five - key messages

Define your key messages at the beginning of your PR campaign and stick with them. There are bound to be some circumstances in which you will need to change your key messages, such as a clinical trial that does not report as expected or a need to respond to competitor activity. However, this is not the norm and in the majority of cases you should not need to change your messages regularly.

Keep your messages simple and few in number - preferably no more than three. The more confusing the messages the more confused your target audiences will be and the less likely you will be
to succeed.

Your key messages for the boat:

  • You are the best candidate for the seat on the boat
  • You are an excellent chef
  • Your food will keep up the strength of the crew until you reach habitation
  • You are resourceful at finding ingredients.

Survival tip six - tactics

Tactics spell out what you are going to do to implement your strategy. After deciding on each tactic a good tip is to ask yourself - is it in line with my strategy and will it deliver my objectives?

If your strategy to get on the boat is to demonstrate your skills as a chef then one of your tactics may be to ensure that the captain stumbles upon you collecting wild mushrooms while on his daily walk around the island. Another tactic may be to deliver him a selection of dishes you have cooked to keep him going while he interviews
your competitors.

Survival tip seven - creativity

Be creative - sometimes the best tactical ideas come from the most surprising members of the PR team. Try to involve a broad mixture of marketing professionals in developing your PR campaign, they will bring knowledge and inspiration from different parts of the business and may help you to think around a problem in a different, more creative way.

Some PR campaigns require the hard slog, but often the most successful are those hinged on a really creative idea, capturing the minds of the target audience and encouraging them to take notice of what was being communicated.

Creativity on the boat may be in finding out that today is the first mate's birthday and using your culinary skills to bake him a cake.

Survival tip eight - proper planning...

Do not underestimate how important planning is in your PR campaign. In order to keep ahead of your competition and to ensure your campaign's success, you must consider potential scenarios and how you can prepare yourself to avoid or cope with them. Some people call this issues management, but a better term is issues preparedness. It is much more effective to plan in advance how you will cope with something than attempt to manage it when it occurs.

A good example is a NICE review of a product. Although involved parties are now much better informed of the progress and discussions within a review, this is still a valid example to consider in terms of planning for both a positive and negative outcome. Consider how each outcome may affect your current PR campaign and the impact each would have on the achievement of your objectives.

PR events should also be well planned for and prepared. Everything you do in relation to communicating your product has an implication for its PR - the relationship with its public. Being badly prepared at a meeting is unprofessional and has a negative impact on your target audience. Plan well in advance and consider all eventualities - is there spare equipment should any of yours fail? How would you react if half the delegates do not arrive? What if there are travel problems? And how will you handle awkward questions about the product?

Being flexible to change is a core skill in PR. The best impression is created by someone who keeps calm in a crisis because they have the confidence to manage a changing situation ensuring minimal impact on the success of the PR campaign and achievement of
its objectives.

Your prior research will be invaluable in this area because it should have highlighted possible issues that may arise, allowing you to time to avoid them or prepare in advance.

Proper planning will ensure you have a strategy in place when it comes to securing your place on the boat. Issues you could consider and plan for include a potential change in the weather - what if the boat needs to leave early or stay longer? How would this effect your campaign? How would it change the competition and what if one of your fellow islanders turns out to be the next Jamie Oliver?

Survival tip nine - evaluation

Despite many years of prevarication from both clients and PR practitioners, it is now generally accepted that PR can be measured and its value
clearly demonstrated.

A simple and clear guide to evaluation in healthcare PR is provided by the Healthcare Communications Association. The Evaluation Toolkit was developed in 2003 and was a collaboration of both industry and healthcare agency professionals.

It is important to evaluate a PR campaign to gauge its success - did it meet its objectives? Which tactics were most effective? Did the campaign deliver a good return on investment? How could it be improved upon in the future?

The objective of the boat campaign was to obtain a seat and passage away from the desert island - if this was achieved then the campaign was a success. If you didn't get the seat on the boat and were out-smarted by a fellow islander, as a PR professional, perhaps the title of your next campaign should be 'how to convince the other two we are better off on the island anyway!'

ABPI (Association of the British Pharmaceutical Industry)
Manages advertising and promotion of prescription medicines through the 'Code of Practice'.

PMCPA (Prescription Medicine's Code of Practice Authority)
Authority established by the ABPI to investigate breaches of the Code of Practice and discipline member organisations in breach of the code.

IFPMA (International Federation of Pharmaceutical Manufacturers Association)
Manages international advertising and promotion of prescription medicines through the 'Code of Pharmaceutical Marketing Practices'.

MHRA (Medicines and Healthcare products Regulatory Authority)
An agency of the department of health that monitors advertising and promotional practice, raising matters of concern to the relevant industry bodies in the UK.

PAGB (Proprietary Association of Great Britain)
Administers the 'PAGB Medicines Advertising Codes - Codes of Practice of Advertising Over the Counter Medicines' with separate codes for medical professionals and consumers.

List of services commonly provided by PR practitioners in the healthcare industry

  • Advocacy development
  • Disease awareness campaigns
  • Media relations/press office
  • Strategic counsel
  • Medical education
  • Issues preparedness/ management
  • Media/presentation training
  • Event and conference management
  • Evaluation
  • Corporate identity
  • Lobbying.

P for promotion - common methods of promotion within the marketing mix

  • Advertising
  • Sales promotion
  • Personal selling
  • Public relations
  • Direct marketing
  • Viral marketing
  • e-marketing.

SWOT and PEST

Topics to consider when developing a SWOT analysis:

  • Strengths (internal) - The key attributes of your product, eg, more efficacious, acts faster, longer acting, improved mode of administration, new chemical entity, good key opinion leader support, larger sales force etc
  • Weaknesses (interna) - The negatives, eg, not SMC approved, not once a day, slow to act, expensive, etc
  • Opportunities (external) - Things on which you can capitalise to give you an advantage over competitors, eg, they had a negative NICE review, corporate mergers, new guidelines are coming out in which you are included, a documentary on the benefits of product is about to be broadcast, competitor sales and advertising materials have been withdrawn due to a code breach
  • Threats (external) - Forthcoming events or situations that could have a negative impact on your product, eg, generic competition entering the market place, new competitor products due to be introduced in the next year, competitor has new data coming out proving their superiority over your product.

Topics to consider when developing a PEST:

Political factors:

  • What are the current regulations under which you must operate, eg, treatment guidelines, ABPI, SmPC?
  • Does the disease area feature in the GP contract?
  • Is the disease area high profile, does it have a lot of political backing, eg, breast cancer, heart disease?
  • Has NICE/SMC approved the product, treatment class for use?
  • Which professional/patient organisations are connected
    to this disease area?
  • Who is the primary care giver (primary or secondary care)? Which other healthcare professionals are involved? What role do social services play in the treatment?

Economic factors:

  • What is the cost of your product compared with your competitors?
  • What influence does price have on treatment decision?
  • Is there any generic competition for your product?
  • Will any competitor products be launched in the near future and what impact is that expected to have on market share?

Social factors:

  • What sections of the population are affected by this disease:
    age, race, sex?
  • What social factors increase the risk of disease: exposure to chemicals/allergens, alcohol/drug abuse, obesity?
  • What is the general awareness of the disease among the public and is more education required?
  • What is the level of interest and support for the disease area?
  • What is the media interest in the subject, which journalists write regularly on the topic and how many publications are dedicated to this area?

Technological factors:

  • Is your product a new technological advance?
  • What recent advances have there been in this area?
  • What is the future direction of treatment?
  • How is this technology perceived?
  • How is your product administered and how does this compare
    with your competitors?
  • Are other modes of administration expected in the future?

The Author
Cherry Wood is the managing director of Athena Medical PR. She can be contacted at cherry@athenamedicalpr.com or on +44 (0)20 8956 2290

2nd September 2008

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