Dispelling the silo myth

The future for medical education in the UK looks bright, as NHS reforms and the consequent evolution in pharma's thinking serve to drive it to the fore in pharmaceutical marketing. But to appreciate fully why the medical education offering is coming into a period of what many are predicting as unprecedented growth, we need to cast an eye over our recent past.

Public relations (PR) in the early 1990s
was still quite new to healthcare, with
practitioners striving hard to wrestle budget allocated for it away from the successful advertising agencies. As the decade progressed, however, the appeal of the PR discipline grew markedly in pharma circles, while at the time medical education remained a background figure, often concealed in the shadows.

People's perception of medical education, probably quite rightly, were of PhD-primed intelligentsia sitting under angle-poise lamps writing up scientific papers at three in the morning. The service they provided was an intensely specialised discipline deployed usually long before a medicine was launched. Back then, little connection was acknowledged between the hard science and sales.

Things are quite clearly different today, but it wasn't until the late 1990s that we saw medical education evolve and take on a new significance and power within the marketing spectrum, which has developed ultimately into something of a fight for the common ground with PR and creative agencies.

Medical education agencies became able to flex their muscles a lot more overtly on the basis that, as they had been involved with a drug from phase II/early phase III, learning about the product and focusing on its core benefits, they were in a strong position to support its launch and post-launch activities as well. The messages they were delivering were also seen as substantive, backed up by credible scientific data.

PR agencies were (and are still) known and highly respected principally, some would argue, for their effective media relations work. This of course included striking up relationships with key opinion leaders (KOLs) who might have been happy to comment in the news on the next new 'wonder drug'. Yet, as medical education agencies also by this time considered themselves architects of effective relations with KOLs ñ having worked with them to support and endorse the clinical positioning ñ the contest for this common ground gathered pace.

This brings us to 2007, where the tussle for share of voice and differentiation continues with PR and medical education each claiming to 'own' the modern marketing communications space.

It is quite understandable how and why this situation has arisen, however, speaking frankly as a practitioner who started his career in PR and latterly moved into medical education, my view is that PR should not be considered an isolated and bespoke marketing discipline. But neither should medical education.

The pharma industry talks about PR, medical education, advertising/creative and market research as if they're all separate ingredients in the same meal ñ but this is a meal where each individual element is eaten separately and on its own, one by one, rather than bringing them all together, mixing and matching to make something better.

Having developed separate briefs for these individual disciplines, pharma then, arguably, becomes confused when each of the PR, medical education and creative sectors all retort, 'yes certainly we can help, but did you know we do so much more than just PR/ med ed/ advertising?' The industry has been historically, and remains to this day, keen to compartmentalise these activities, segregating each from the other quite effectively, meaning that we have a kind of self-fulfilling prophecy: this is how it starts out, a collection of relatively detached briefs, and so this is how we work.

In fact, the communications continuum comprises a series of interrelated tactics, not interrelated disciplines, so when we talk about the future of medical education, creative or PR we should be talking simply and solely about medical communications.

One powerful entity, not three distantly related activities
Within this sphere of assimilation, if PR's expertise lies in creating effective media relations, then perhaps that should be a key tactic within an overarching marketing strategy, just as publications planning is one part of a medical education strategy and journal advertising is only one element of a creative brief.

To move forward, agencies and the industry both need to stop putting tactics into silos. It's time we started looking for true product, brand or service offering integration, as this is what will enable pharma to be the best partner it can be to the NHS.

In this regard, I foresee a dramatic increase in the marketing effort put behind non-sales-representative-based activities. We still need the face-to-face calls, but in line with the shifting sands of the NHS companies' need to call on different people, in a different way, and with a different set of messages.

This is not new, but it is really only now that we are seeing a dramatic change in sales force alignment to evince a true understanding of the job functionality of those PCO-based individuals who are not medically qualified, but who are gatekeepers of funds, access and policy.

Given all that is happening in the NHS and with the changes being implemented by pharma as it seeks to gain efficiency in its salesforces, I think we're going to see medical education rising to the higher ground, just as PR gained favour in the early 1990s at some expense to advertising.

In fact, there is already evidence of this if you consider the number of advertising and PR agencies starting to defend, or looking to further grow their businesses by offering medical education services, and creating medical education divisions and offshoots. By contrast, we're not seeing medical education agencies creating PR divisions in order to win more business. The ultimate conclusion, if we believe that past performance, or history, is the best predictor of future behaviour, is that medical education in its current guise has an advantage going forwards.

I believe this is because these agencies are able to offer a more rounded proposition with respect to overall marketing strategy. If you're a PR agency, you are unlikely to recommend to a pharma company that it spends, for example, 40 per cent of the budget on publications, because that is outside of the classic scope and expertise of a typical PR agency, and you'll understandably want to keep the budget targeted at your agency.

The medical education business, on the other hand, takes a far more rounded and holistic approach by looking to truly integrate the various tactical elements of communications into programmes that begin with high-level scientific publications of phase II/early phase III data, but which also culminate in patient, payer and clinical support for the brand post-launch, which involves media relations!

I am not knocking PR, far from it. But I do see the beginning of a further divide between PR and medical education now and in the future, in that PR could go more towards consultancy in the same way that IBM moved from selling computers to selling management consultancy and Anderson went from accountancy to consultancy. There is a compelling argument for the higher value attributed to consulting rather than the selling of 'stuff'.

But it's also salient that with an increasing number of PR agencies boasting add-on educational 'offshoots', in a bid to align their offering more closely with pharma's new challenges, it serves to perpetuate the myth of medical education and PR being separate marketing silos. In my view, we should be talking wholesomely about an all-embracing unified approach to the practise of medical communications.

First and foremost we, with our roots either in PR or medical education, should be brand communication strategists with everything else then following as a tactic within a defined plan. With the pharma industry's recognition that credible medical education programmes will help them reach existing and new customers the most valuable position for us as communication experts must be to promote the holistic approach.

There is another key point to make in this. Integration is a term on everyone's lips, though frankly I would argue that it has become a buzzword for a vogue concept that has become overused, over-promised and, as yet, seldom truly delivered.

It's not necessarily easy or brilliantly advantageous to mash together what have been considered, historically, separate marketing silos in the hope that they will somehow help each other out. The benefits for the brand will come through development of a rounded, balanced unified team whose joined-up thinking enables it to talk to customers through sensitive and empathetic communication initiatives.

Today, the people you find in a good medical education agency are markedly different from those intensely focused super-brains of the early 1990s. Naturally, the perceptive science writer is still central to the team, but they now work in daylight hours and in partnership with great communicators who may have PR backgrounds; brand strategists who might come from pharma, the consumer sector or management consultancy; plus event planners who can come from anywhere if they know their onions.

Medical education offers a much broader range of skill sets today, which consequently means that its offering to the pharma industry is vastly more pervasive. A greater breadth of experience brings with it new and valuable depths of expertise, making a good agency an indispensable partner for pharma companies in their challenge to identify and strike up effective relationships with the new range of health service points of contact.

So let's dispel the silo myth. PR and medical education should not be seen as cousins thrice removed, but as one and the same operators in a cohesive marketing services offering. Pharma is changing, and with that the agency world needs to change to ensure that we all move forward in the new healthcare dimension we face.