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Lessons from the US

What can the UK learn from US self-regulation?

Close-up of a green US chalkboardThe dawn of the New Year saw the Association of the British Pharmaceutical Industry (ABPI) making good on its resolution to increase transparency and trust between the pharma industry and health professionals. On the first day back on the road, pharma reps carried a rather lighter load as new regulation clamped down on the distribution of drug branded freebies.

The 2011 ABPI Code of Conduct came into effect on January 1, featuring a number of new and amended clauses aimed at improving the reputation of healthcare marketing practices in the UK. Among the changes are clauses relating to disclosure of payments to health professionals, the role of pharmacists as medical signatories, and most significantly for some, the use of promotional gifts.

Under the revised code, the ABPI has prohibited its members from providing branded promotional items to health professionals, with the exception of inexpensive items to be passed on to patients as part of a formal support programme. This means that branded pens, mugs, mouse mats, pads and any other items that may be viewed as an 'inducement to prescribe' can no longer be gifted by reps. A four-month grace period will see the new clauses become fully operative on May 1, 2011.

Simon Jose, president of the ABPI said: "We want to shift the debate to focus on how we can improve health outcomes for patients through science and innovation."

Refocusing relationships
The relationship between industry and professionals has evolved along similar lines in the US in relation to promotional items. Back in 2009, self-regulatory body Pharmaceutical Research and Manufacturers of Americ (PhRMA) introduced a new code that aimed to refocus professional relationships on 'informing the healthcare professionals about products, providing scientific and educational information, and supporting medical research and education'. The PhRMA 09 code, which is legally binding in some states, stipulated that no promotional items could be distributed to health professionals apart from purely educational items. Two years on, valuable lessons can be learned from the strategies US pharma marketers have used to engage health professionals. So how did the industry adapt to this changing regulatory climate?

Knowledge as currency
Promotional giveaways have long been used by reps as a way of gaining valuable face time with medical staff and creating brand awareness among health professionals. But some have argued that these acts of largess overshadow the function sales reps perform as professional experts in disease treatment.

The PhRMA code says reminder items 'may foster misperceptions that company interactions with healthcare professionals are not based on informing them about medical and scientific issues'.

The role of pharma reps as an information source for physicians is often overlooked in the debate. A knowledgeable rep provides a ready way of accessing the wealth of treatment information and clinical data that the industry invests heavily in.

Post 2008, information has become the new currency in trade for our US counterparts who are redirecting spend into developing type of educational tools that the code promotes. Claire Edmondson, senior product manager for the drug Lovaza at GlaxoSmithKline (GSK) said: "Basically, we're not giving out any pens, pads or premiums. Anything that is not medically relevant... anything we give to the doctor is going to be educationally based."

A trend has emerged for brands investing heavily in information assets. A recent survey of healthcare sector companies exhibiting at trade shows found that 47 per cent are investing in scientific or research giveaways versus just 22 per cent before the introduction of the code. In addition, 55 per cent are distributing educational materials – up from 22 per cent prior to the new regulations.

New tools for sharing information
Key opinion leader programmes and the development of disease state information resources are popular strategies, and reps are being armed with promotional aids to disseminate educational content. In addition to traditional print materials, marketers are looking to innovative technologies to make content accessible and to bring it to life. Audio and media playing devices are being used to share video and audio clips of KOLs sharing their insight into treatment and emerging research.

Digital channels have played a major role in sharing knowledge with health professionals. It's no surprise, that along with the rest of the world, more doctors are using the web as their primary information resource. A 2010 comscore report found that 50 per cent of US physicians were connecting with pharma companies online, and spend on communicating with health professionals digitally is up. According to FirstWorld Pharma a study published in September 2010 found that two-thirds of pharma industry executives expect a proportional increase of digital spend in 2011.

US pharma is investing in comprehensive information hubs focused on disease states, research and therapy options. A prime example is Novartis' Virtual Oncology Center (VOC), which has attracted plaudits across industry awards. An interactive tool for healthcare professionals involved in the treatment of cancer patients, the VOC creates a virtual environment where professionals can interact with educational resources including patient case studies, Q&A videos, web conferences, e-learning modules and patient resources.

"The changes in the marketplace represent a fundamental opportunity for companies to build new multichannel promotional and educational models and develop new ways of doing business" said Dr Rajesh Nair, president and CEO of Indegene who developed the VOC.

Changing role of the rep
So if health professionals are helping themselves to information online, and sales reps can no longer drop branded goodies off at the surgery or take the doctor out to lunch, have they been rendered obsolete? US reps have just cause for concern. A TNS survey found that 1 in 5 US prescribers work in a practice that refuses to see drug reps, and recent years have seen drastic lay offs by major industry players.

But evolution does not have to mean extinction – and these are symptoms of what the code acknowledges as the need to foster a relationship based on improving patient care. Educated and informed reps who can talk to healthcare providers on a peer-to-peer basis about medical conditions, treatment options and clinical research are most likely to escape the axe.

The physical to digital relationship
A smarter, smaller salesforce is emerging as the conduit to industry knowledge and this relationship will be enhanced, rather than threatened, by digital channels. While major investment is being made in online assets, pharma companies still need to find ways to drive physicians to their resources, and reps play a key role in creating awareness for digital information assets. Novartis' integrated approach embraces reps and sales aids as key drivers of traffic to the VOC.

The cross channel nature of physician engagement is being acknowledged – the premise being that the conversation starts in the real world with a rep or direct mail piece, and continues online with web assets. New 'physical-to-digital' technologies are gaining popularity as sales aids. One such example is the iKyp webkey, a customisable print format incorporating a patented USB technology that seamlessly launches web destinations when plugged into a computer.

Tibotec Therapeutics has used this tool to provide healthcare professionals with a convenient access point to web-based educational assets on HIV-1 epidemiology, diagnosis and antiretroviral therapy. Distributing iKyp webkeys as rep delivered sales aids and conference handouts has resulted in a 36.3 per cent response rate.

A key attraction of such physical-to-digital tools, is that they provide measurable engagement, providing a wealth of analytic data that can be fed back into closed loop marketing strategies. Marketers can trace which physicians are most responsive to representative-provided materials, and see which digital content they are interacting with. This enables brands to refine future activity based on what works – resulting in better content for physicians and better RoI for their tactics.

The patient path
Under the UK's updated ABPI Code, pharma companies can provide health professionals with support items intended to be passed on to patients. In the US, patient support items are being used as a way of creating brand visibility in doctors' offices where logo coffee mugs and pens are now ruled out.

Take-home information kits for patients starting a new prescription treatment are commonly provided to physicians by representatives. These typically feature information on managing a condition, dosage and treatment information, and often links to online tools that provide support and allow patients to monitor their symptoms.

Under the new ABPI code, the only patient support items that can remain in the doctors office are those that 'allow patients to gain experience in using their medicines'. In the US, educational aids that help healthcare professionals explain disease and treatments continue to be used, and companies that specialise in custom anatomical models have received a boost from the PhRMA '09 code updates.

Artcraft Health Education has picked up a number of awards for their educational tools including a 3D model for Pfizer Oncology which can be used to demonstrate the changes to the kidney across the four stages of renal cell carcinoma.

Disease awareness campaign materials are another permissible application, and US drug manufacturers are providing surgeries with waiting room materials designed to educate patients about specific medical conditions. In the UK, particular care needs to be taken to ensure that such items do not promote the use of a specific medicine.

The manufacturer of one of the US' leading human papillomavirus (HPV) vaccines provided doctor's offices with pocket-sized audio guides that allowed young women to listen to the stories of HPV sufferers and gave them a check list of questions to provoke discussion of the condition with their doctor.

Embracing change
The most important lesson that we can take from the US learning curve is that change should be embraced rather than feared. This year hasn't started with a painful regulation hangover for marketers who have long-supported the trend towards a patient care-focused relationship with professionals. For them January 1 was just another day in an industry that they can feel proud is playing an important role in the ongoing education of healthcare professionals.


Takeout tips for UK marketers

Adhere to the spirit of the code
Some will be frustrated by the lack of specific examples of what the code prohibits, others will see this as an opportunity for creative interpretation. Sticking to the spirit of the code rather than the letter will help you avoid falling foul of the ABPI.

Seek guidance
Ask yourself honestly: 'Will this improve health outcomes for patients?' If you are still unsure whether an activity will be compliant, you can seek advice from the Prescription Medicines Code of Practice Authority (PMCPA), who administer the ABPI Code and provide guidance on its application.

Create easy ways to access information
Doctors may value your educational assets more than promotional gifts, but are short on time to consume them. To realise investment on your information resources, create tools that allow health professionals to access and navigate them on their own terms, quickly and easily.

Invest in the right people
For doctors to view drug reps as valuable, trustworthy peers, they need to be able to hold their own when discussing medical conditions, therapies and clinical research. Reps with a medical background and training initiatives are sound investments.

Embrace the creative challenge
The code changes can provide an opportunity to pull out in front  of competitor brands who are slow to respond creativity. Rather than tweaking existing tactics to comply with regulation, seek out new and innovative ways of rising to the challenge.


The Author
Linda Miller is creative communications manager at Kyp

To comment on this article, email

17th February 2011


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