Beyond the greenhouse

Henry VIII was one for expansion and bringing different talents into one united system and, as Medicom currently resides in his back garden at Hampton Court, perhaps it's unsurprising that we have just joined Euro RSCG Life's network, within the global communications leviathan that is Havas.

Was this a rally to answer pharma's global call with all-embracing communications, or just another independent agency selling out to the big boys? Well I feel it's the more wholesome option because it embodies the next strategic move in a global high jump competition, where the bar has just been raised.

Already the model of choice for myriad creative marketing agencies, the union of multiple talented independents under a single network parasol is, to a large extent, the inevitable result of the global pharmaceutical market.

Without multi-market dexterity, agencies today cannot get anywhere near the big, exciting international accounts; even the finest independents in class are distanced from the global procurement contracts because they're outside the 'international circle' – those specific, named worldwide providers.

Creative agencies got around this by joining networks, winning global work and producing stunning local tactics (with excellent global brand consistency) off the back of it. This is quite the accepted norm for ad agencies and has been for some time. So what about achieving the same with medical communications? Is now the time?

Inexorable march
Market access and customer education are now under the influence of this global force, obliging key players to take the broadest of macro views in sustaining professional growth beyond a critical mass. This is the only way to meet global procurement departments on a level playing field.

It also explains why our medical communications agency, located on the edge of Henry VIII's vegetable patch, now sits like a prize marrow within the esteemed Euro RSCG Life asset of Havas, one of the world's foremost communications goliaths.

Medicom Group, even if I say so, has yielded seasoned fruit for clients, like a tomato plant tended meticulously. But then we smacked our head squarely on the glass ceiling of the greenhouse. Even as an established, award-winning group handling UK and European accounts, the price for our independence was an unspoken, yet clear segregation from those with access to the global pitch list.

Global procurement deals meant we couldn't be heard, no matter how proudly we laid out the appropriate vegetables, or how highly our work was rated. We were, and remain, respected as a regional specialist, but now with vastly expanded jurisdiction; as happened for the creative advertising agencies, we too can adhere to a proper definition of global.

Leafy, unassuming Hampton Court in West London, spattered with its organic cardboard shops and riverside bistros, is now a European med comms hub within a wheel of marketing expertise shared between 233 offices in 75 countries.

But it's not an exact replica of the creative model; that is, 'global' in med comms isn't necessarily the same as 'global' in advertising.

The principles underlying the union of independents are equal: to deliver consistency of message and maximise return on investment (ie, don't do it 50 times, do it once and adapt it a number of times, so you avoid paying for origination in each and every market).

But while I do not underestimate the mountainous challenge in rolling out global creative, likewise, the complexities of international market access are not for the faint-hearted.

So what is the jurisdiction of a global med comms organisation?

Adaptable influence
Market access has become quite the buzzword around the industry in recent years, but it can be heinously complicated. What was an umbrella term, chiefly denoting the mechanics of clearing the regulatory process before the eager end user started prescribing, is now used more often to describe the economic argument. It reflects the changing focus of a cash-strapped global healthcare system.

Needless to say, if one considers the UK's Pharmaceutical Price Regulation Scheme (PPRS) complex, the vast and subtle differences between the world's markets in terms of pricing and reimbursement, payer and physician education, formulary access – to name but a few areas of market access – clearly calls for the far-reaching talent of an expertly knowledgeable network.

As with global branding, it is almost impossible to create med comms activities that work in every EU member state. The real challenge is to identify the points of commonality and dissimilarity, then provide initiatives and materials that are tiered accordingly so as not to satisfy simply down to the lowest common denominator.

Guidance based on a targeted cascade of activities will, therefore, bring the smaller markets into the picture, while embracing the needs of the commercially powerful Western regions. It also enables pharma to adapt its activities with the intelligence, knowledge and sensitivity the task demands.

It's about developing internationally pliable tools that fuse locally-driven acumen within consistent, measurable frameworks.

It is impossible to do this cost-effectively without a wealth of local expertise feeding into an inclusive, global network of delivery vehicles, which is particularly true of today's requirements around pharmacovigilance and use of the web as a monitoring and communications instrument.

The vigilant domain
There is a clear trend for pharma to reach and educate healthcare professionals on disease conditions and treatments, in tandem with a decline in traditional marketing spend on, for example, salesforces and attendance at costly global congresses.

A savvy international medical communications company should look to create the tools for regional and global digital education initiatives that put the information healthcare professionals seek straight into their hands, via a pull – and not push - mechanism.

The internet is perhaps the greatest search tool of our time. This is pertinent because people – patients, consumers, doctors, car buyers, anyone – are decreasingly responsive to, and accepting of, the information thrust upon them.

Rather, they desire to search, to find and to pull it towards them by their own power. The future is about individuals seeking and finding what they actually want; although a good search process can also play a role in enlightenment.

The internet is great for this, but engagement online requires vigilance on the parts of both provider and consumer, but especially the pharma company.

What happens when Google Alerts identifies a 'content producer' purporting to be a patient whose dose of medicine, they claim, led to severe headaches, gout and post-nasal drip? What if two other comments appear citing the headaches too, but adding slight breathlessness as well?

Duty bound
Whether or not these appear to be credible and regardless of whether they are known or unknown side effects, they are ostensibly reported adverse events. As such, the pharmaceutical originator is duty bound to investigate and triage the assertion, informing the regulatory authority with jurisdiction as appropriate and/or as required.

However, pharma cannot be seen as playing 'Big Brother'. Despite the open and accessible nature of internet blogs, chat rooms, discussion forums and other online venues for posting personal commentary, users of these sites consider them quite private – and will defend against what they see as 'prying corporate eyes'.

Only an approved, documented system to ensure overt compliance with relevant pharmacovigilance mandates around the world will protect companies fully from the insidious risks when handling what purports to be the 'online disgruntled, or misinformed patient'.

This is particularly pivotal now, as we wait to see whether EC Commissioner Verheugen's proposals on enhancing communication to patients succeed in becoming implemented in Europe.

So rather than run, screaming, away from globalisation and its impacts, it is simply a matter of peeling away the regulations, identifying and understanding the common features in markets and creating robust pharmacovigilance strategies acceptable to regulatory authorities.

This is more easily said than done perhaps, but it's a sure-fire bet that without the true multi-national grasp of worldwide groups such as Havas, the healthcare marketing services sector may start to lag behind pharma's increasingly global manoeuvres.

This is why we sold 60 per cent of Medicom Group into Euro RSCG Life. We were simply a well-tended tomato plant, which sought to grow beyond the glass roof of the greenhouse.

When deals like ours are made public, it takes little time before people start questioning to what degree these things are cyclical.

For agencies, so long as entrepreneurs leading large network groups break out and set up their own entities, and then sell them back into the large groups once they reach critical mass, we will always see this cycle. It's built in to the process.

Tipping point
But for pharma, and globalisation of industry in general, we are dangerously near a tipping point; if not already beyond it. Despite the reservations politicians now place on global banking, once the world is hooked up and operating on a universal level, that space becomes the centre for all business.

There will always be room for talented, specialist independents, but as pharma's business continues to become increasingly global, so does its requirement for a like-minded core of service providers.

The Author
Martin Ellis is chairman of Euro RSCG Life Medicom, part of Havas. He is also the winner of the 2009 Communiqué Lifetime Achievement Award. Martin began his career as a nurse before moving to pharma company, Marion Merrell Dow. In 1993 he joined the Board of Burson-Marsteller. He started at Cohn and Wolfe in 1995, becoming its MD in 1999, and acquired Medicom in 2003, which he rebuilt and relaunched as the Medicom Group. In recent months Euro RSCG Life bought a majority share in the company.
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